Observational study of airway changes in robotic-assisted laparoscopic surgeries in the steep Trendelenburg position after a short period of post-operative ventilation

INTRODUCTION: Upper airway oedema seen in robotic-assisted laparoscopic surgeries (RAS) in steep Trendelenburg position (STP) can lead to airway complications. In this study, we evaluated airway changes in RAS after a short period of post-operative ventilation and analysed intraoperative factors contributing to these changes. PATIENTS AND METHODS: This prospective observational cohort study was conducted on 70 patients undergoing RAS in STP. Our primary aim was to assess changes in Samsoon and Young modification of Mallampati classification (MMS) and neck circumference (NC) at 30 min and 4 h post extubation after 30-45 min of ventilation in head up position in the intensive care unit. We studied the association between airway changes and intravenous fluids, duration of surgery and STP. The statistical analysis was performed by the Shapiro-Wilk test, Friedman test, Nemenyi test, Stuart-Maxwell test and Spearman correlation test. P < 0.05 was considered statistically significant. RESULTS: There was a significant change in post-operative MMS (Stuart-Maxwell test: χ2 = 29.000, P < 0.001) and NC (P < 0.001) (Friedman test) at 30 min post-extubation. Four hours later, the changes were not significant. There was a statistically significant weak positive correlation between intake (mL) and change in NC (30 min post-operative) (rho = 0.29, P = 0.015) (Spearman correlation test). CONCLUSION: In robotic-assisted laparoscopic surgeries, there was a significant increase in MMS and NC at 30 min despite post-operative ventilation for at least 30 min. Intraoperative fluids had a positive correlation with NC changes.