Prevention of Endotracheal Tube Migration by Cuff Palpation During Robotic Surgical Procedure

Study Overview
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Brief Summary
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After intubation, the endotracheal tube was finally fixed after palpating endotracheal cuff at three sites (just below the cricoid cartilage, at suprasternal level and just below suprasternal notch). Fibre optic bronchoscopy will be done to find distance between tip of endotracheal tube and carina. This distance will be measured repeatedly, after pneumoperitoneum, after trendelenburg position and after making the patient supine at the end of surgery. Change in the distance will be noted.

Detailed Description
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The endotracheal tube (ETT) will be placed according to the black mark on the tube, post-intubation, the tube will be finally fixed after palpating endotracheal cuff at three sites (below cricoid cartilage, at suprasternal level and just below suprasternal notch). ETT cuff position will be scanned by sonography of airway to confirm the position of the proximal end of the ETT cuff. Fibre optic bronchoscopy will be done to find distance between tip of endotracheal tube and carina. This distance will be measured repeatedly 5 minutes after pneumoperitoneum, 10 minutes after trendelenburg position and 10 minutes after making the patient supine at the end of surgery. Change in the distance will be noted to confirm the migration of ETT.

Official Title
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To Evaluate Three Point Cuff Palpation Technique for Assessing Optimal Depth of Endotracheal Tube Placement.

Conditions
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Robotic Surgical Procedures

Intervention / Treatment
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* Procedure: Three point cuff palpation technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Robotic uro-oncological surgical procedures of perineum Robotic gynae-oncological surgical procedures of perineum Exclusion Criteria: Upper airway fibrosis or tracheal stenosis Large neck swelling distorting or deviating the trachea. Head and neck surgeries Laryngeal and tracheal tumour Tracheal surgery Previous tracheostomy previous radiation treatment of neck

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Three point cuff palpation and Blck mark line technique<br>In Three point cuff palpation technique the cuff will be palpated just below the cricothyroid membrane,at the level of suprasternal notch and below the suprasternal notchand the tube is re-positioned in case of any discrepancy between the black mark line technique and three point cuff at three different over the trachea. | Procedure: Three point cuff palpation technique<br>* the ETT is finally positioned according to the Three point cuff technique.<br>* Other names: Black line mark on the endotracheal tube;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Measure the distance between tip of endotracheal tube and Carina by fiber-optic bronchoscopy and measuring scale at various phases of robotic surgical procedure. | proper endotracheal tube placement is labelled when the distance between the tip of tube and Carina is more than 2.5 cm, after placement the tube by three point cuff palpation technique, its position will be assessed at respective time points. | Throughout robotic surgical procedure, immediately after intubation, 5 minute after pneumoperitoneum, 10 minutes after trendelenburg position and after dedocking and making patient supine.pneumoperitoneum. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| find the effect of cricod cartilage and supra-sternal distance on endotracheal tube tip to Carina distance. | cricoid cartilage to suprasternal distance changes with the position of neck, so it could affect the distance between the endotracheal tube tip and carina as the position of patient changes during various robotic surgical steps. | Throughout robotic surgical procedure, immediately after intubation, 5 minute after pneumoperitoneum, 10 minutes after trendelenburg position and after dedocking and making patient supine. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Endotracheal intubation, pneumoperitoneum, trendelenburg position, Robotic surgery