Tracheal tube tip displacement during laparoscopy in children

The risk of endobronchial intubation during laparoscopy because of displacement of the tip of the tracheal tube is a well known problem in adults. Laparoscopy in children is increasingly performed, but there are no data available regarding the above problem. We prospectively studied 46 children aged 2 months to 15.7 years (median 4.2 years) undergoing laparoscopy. After tracheal intubation with the Microcuff Pediatric Endotracheal Tube, with the 'intubation depth marking' of the tube at the vocal cords, the distance from the tracheal tube tip to the carina was endoscopically measured with the patient in the neutral position and with 20 degrees head-down tilt, both with and without capnoperitoneum. Maximal displacement of the tip of the tracheal tube tip in cm was 0.5 + (0.05 x age (years)) for 20 degrees head-down tilt, 0.6 + (0.09 x age (years)) for capnoperitoneum alone, and 1.2 + (0.11 x age (years)) for 20 degrees head-down tilt with capnoperitoneum. In no patients did endobronchial intubation occur with the tracheal tube placed according to the intubation depth marking.