Frequency of Positive Cuff Leak Test Before Extubation in Robotic Surgeries Done in Steep Trendelenburg Position

Jhanvi S Bajaj; Sudivya Sharma; Niyati Mehta; Akshat Shah; Ganesh Nimje; Manoj Gorade; Gargi Deshpande

doi:10.1007/s13193-022-01605-8

Frequency of Positive Cuff Leak Test Before Extubation in Robotic Surgeries Done in Steep Trendelenburg Position

Indian J Surg Oncol. 2022 Dec;13(4):896-901. doi: 10.1007/s13193-022-01605-8. Epub 2022 Jul 28.

Authors

Jhanvi S Bajaj¹, Sudivya Sharma², Niyati Mehta³, Akshat Shah², Ganesh Nimje⁴, Manoj Gorade⁵, Gargi Deshpande²

Affiliations

¹ Hinduja Hospital, Mumbai, India.
² Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Pin 400012 India.
³ KEM Hospital, Mumbai, India.
⁴ Mahatma Gandhi Hospital and Medical College, Jaipur, India.
⁵ Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.

Abstract

Anaesthesia for robotic surgeries done in steep trendelenburg position are associated with risks such as facial oedema, conjunctival chemosis, raised intraocular pressure, laryngeal oedema, and delayed awakening. We proposed the use of the cuff leak test in them to record the frequency of laryngeal oedema at the end of surgery and attempted to find its correlation with probable risk factors. We conducted a prospective observational study of 100 patients aiming primarily to assess the frequency of positive cuff leak test in robotic abdominal surgeries performed in trendelenburg position. The secondary outcomes were to check its correlation with intravenous fluid administration, duration of pneumoperitoneum, and angle of trendelenburg position. We also recorded the frequency of chemosis, the frequency of post-extubation stridor in 24 h post-operatively, and the frequency of reintubation. Out of 100 participants undergoing elective abdominal robotic surgery in trendelenburg position, ninety were analysed. Total 31.6% (n = 30) participants showed positive cuff leak test. Chemosis was observed in 31 (32.6%) participants. No patient experienced post-extubation stridor or required reintubation during post-operative follow up. There was a no correlation between cuff leak test and intravenous fluid, duration of pneumo-peritoneum, or with angle of trendelenburg. The frequency of positive cuff leak test was high in patients at the end of robotic surgery but none of these patients had post-extubation stridor or required reintubations. There was no correlation with the fluid, angle, or duration of surgery. Clinical Trials Registry of India (CTRI/2017/04/008289), ctri.nic.in.

Keywords: Cuff leak test; Laparoscopic; Laryngeal oedema; Robotic; Trendelenburg.

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