Effect of intensive training and education of health care workers on the maintenance bundle of venous access devices in critically ill patients at a tertiary care academic hospital.

BACKGROUND: The maintenance bundle of care for all venous access devices (peripheral intravenous catheters, PIVC; central venous catheters, CVCs; hemodialysis ports) is important to prevent secondary sepsis in critically ill patients. This quality improvement project analyzed the effect of intensive training and education of health care workers (HCWs) on maintenance bundles for venous access devices. METHODS: The study period comprising of preintervention phase (3-months) included 25 random visits to the intensive care unit for point observations regarding maintenance of all venous access devices in-situ in all intensive care unit patients on the day of the visit. The observations were categorized as appropriate or inappropriate practices based on American Society of Anesthesiologists (ASA) guidelines for CVC 2020, INICC guidelines for PIVC 2017, and Australian Commission on Safety and Quality in Health Care (ACQHCS) for PIVC and hemodialysis ports, December 2019. While the intervention phase (1-month) comprised intensive training and education of HCWs, postintervention phase 3 (3-months) included similar visits and point observations as during the preintervention phase. RESULTS: The maintenance of PIVC improved significantly in terms of the condition of site (from 82.7% appropriate observations to 97.8%, P < .05); condition of connectors (45.7%-56.8%, P < .05), and any attached unused IV sets (90.5%-98.56%, P < .05). For CVC, there was significant improvement in condition of insertion site (66%-94%, P < .01); condition of connectors (0%-44.37%, P < .01); fixation (91%-99.3%, P < .05); any attached unused IV sets (38.9%-97.3%, P < .01) and knowledge of HCW (96.52%-100%, P = .05). For hemodialysis ports, no significant improvement was observed. CONCLUSIONS: Intensive training and education of HCWs led to significant improvement in the maintenance bundle of care for PIVC and CVC.

A noninferiority trial on information-based video versus self-selected video distraction technique for preoperative anxiety reduction in school children: Prepare trial.

BACKGROUND: Distraction techniques using smartphones to watch cartoon videos and play videogames have been successfully used to reduce preoperative anxiety in school children. However, the literature about the use of video-based preoperative information technique for anxiety reduction in that age group still remains understudied with conflicting results. We hypothesized that there would be no meaningful difference in anxiety score at induction period between the information-based video versus self-selected video distraction technique. METHODS: Eighty-two children between 6 and 12 years undergoing surgery were randomized to self-selected video (n = 41) and information-based video (n = 41) distraction group in this prospective, randomized, noninferiority trial. Children in self-selected video group were shown video of their choice using smart phones, while children in the information-based video group were shown video of operation theater (OT) set up and induction procedure. The children were taken inside operating room along with parents watching the respective videos. Modified Yale Preoperative Anxiety Scale (m-YPAS), just before induction of anesthesia was recorded as the primary outcome. Induction compliance checklist score, anxiety of the parents, and short-term postoperative outcomes in 15 days (telephonically) were recorded as secondary outcomes. RESULTS: The mean difference in the baseline mYPAS score (95% CI) between the two groups was -2.7 (-8.2 to 2.8, p = .33) and -6.39 (-12.74 to -0.44, p = .05) just before the induction period. The upper bound of the 95% CI did not cross the value of 8, which was the noninferiority margin decided prior to study commencement. 70.73% cases had perfect induction in the self-selected video distraction group, compared to 68.29% in the information-based video group. After 15 days of postoperative follow-up, participants in the self-selected video group had a larger proportion of negative outcomes (53.7%) compared to information-based video group (31.7%), p = .044. CONCLUSION: Information-based technique using smart phone is non inferior to self-selected video-based distraction-based technique in decreasing PA with an additional advantage of decreasing postoperative short-term negative outcomes. TRIAL REGISTRATION: CTRI identifier: CTRI/2020/03/023884.

Effect of duration of pneumoperitoneum on renal function in patients undergoing laparoscopic surgeries: a prospective observational study.

This study aimed to assess the effect of pneumoperitoneum and, thereby, raised intra-abdominal pressure for different durations (≤ 1 h, 1-3 h and > 3 h) on renal function. One hundred and twenty adult patients were allocated to four groups-the Control Group A (N = 30; patients undergoing non-laparoscopic surgery) or Group B (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum < 1 h) or Group C (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum 1-3 h) or Group D (N = 30; patients undergoing laparoscopic surgery with duration of pneumoperitoneum > 3 h). The baseline, intraoperative (at the end of pneumoperitoneum/surgery), and postoperative (after 6 h) values of blood urea levels, creatinine clearance, and serum cystatin C were compared. The results showed that the raised IAP (10-12 mmHg) and varying durations of pneumoperitoneum (from less than 1 h to more than 3 h) did not significantly affect renal function measured in terms of change in serum cystatin levels from baseline to 6 h in postoperative period. The varying durations of pneumoperitoneum also did not significantly affect serum creatinine or blood urea levels in the postoperative period. CTRI registration: CTRI/2016/10/007334.

Ultrasound Evaluation to Predict Difficult Laryngoscopy in Children below 2 Years.

OBJECTIVE: To evaluate the feasibility of sonography as a tool to predict difficult airway in children less than 2 y of age. METHODS: Airway ultrasound was performed in 90 children below the age of 2 y to measure airway dimensions preoperatively. Hyomental distance ratio in predicting difficult laryngoscopy was recorded as the primary outcome. Secondary outcomes included tongue thickness/oral cavity thickness ratio and tongue thickness/thyromental distance ratio in predicting difficult laryngoscopy and difficult intubation, time taken for intubation, and any complications. The sensitivity, specificity, positive predictive value, and negative predictive value with 95% CI of all the parameters were recorded. RESULTS: Six out of 90 (6.7%) patients had difficult laryngoscopy. HMDR was significantly different between children with easy and difficult laryngoscopy (1.15 ± 0.11 vs. 1.03 ± 0.016, p = 0.001). The optimal cutoff points for HMDR, TT/OCT, and TT/TMD to predict difficult laryngoscopy (CL grade III, IV) were > 1.055 (sensitivity 100%, specificity 86.9%), 0.755 (sensitivity 100%, specificity 57%), and 0.445 (sensitivity 53.5%, specificity 66.7%), respectively, the AUC being highest for HMDR (0.959). The cutoff value of ≥ 1.055 of HMDR to predict difficult laryngoscopy had the highest AUC of 0.959, p < 0.001. Fifty-two children had IDS = 0, while 38 had IDS between 1 and 4. None of the patients had IDS > 5. CONCLUSIONS: Ultrasound-guided airway assessment is a feasible option in children less than 2 y. Hyomental distance ratio can form a useful tool for predicting difficult airway in this age group. TRIAL REGISTRATION: The trial has been registered in Clinical trial Registry of India (CTRI/2019/05/019014) before enrollment of the first patient.

Intravenous versus inhalational anesthesia trial for outcome following intracranial aneurysm surgery: A prospective randomized controlled study.

BACKGROUND: For maintenance of anesthesia for intracranial aneurysmal neck clipping, both intravenous and inhalational anesthetics are in vogue. We aimed to evaluate the superiority of one agent over the other for long-term neurological outcomes in these patients. METHODS: This prospective assessor-blind randomized study was conducted in 106 patients of 18-65 years of age with World Federation of Neurosurgeons Grade I-II of subarachnoid hemorrhage. After written informed consent, the patients were randomized into - intravenous group (Propofol) and inhalational group (Desflurane). The primary outcome was to study neurological outcome using Glasgow outcome scale (GOS) at 3 months following discharge while secondary outcomes included intraoperative brain condition, intraoperative hemodynamics, duration of hospital stay, Modified Rankin Score (MRS) at discharge, MRS, and Barthel's index at 3 months following discharge and estimation of perioperative biomarkers of brain injury. RESULTS: The GOS at 3 months was 5 (5.00-5.00) in the propofol group and 5 (4.00-5.00) in the desflurane group (P = 0.24). Both the anesthetics were similar in terms of intraoperative hemodynamics, brain relaxation, duration of hospital stay, MRS at discharge and 3 months, and Barthel Index at 3 months (P > 0.05). The perioperative serum interleukin-6 and S100B were comparable among the groups (P > 0.05). CONCLUSION: The long-term neurological outcome of good grade aneurysm patients undergoing craniotomy and clipping remains comparable with the use of either propofol or desflurane. The effect of the two anesthetic agents on the various clinical parameters and the biomarkers of brain injury is also similar.

Efficacy of antifibrinolytics in reducing blood loss during hip reconstruction surgery in cerebral palsy children. A systematic review and meta-analysis.

BACKGROUND: Cerebral palsy (CP) children undergoing hip reconstruction are more prone to blood loss during surgery due to poor nutritional status, antiepileptic medication intake, depletion of clotting factors, and the extent of surgery involved. We conducted this present review to analyze whether antifibrinolytics during hip surgery in CP children would reduce surgical blood loss and transfusion requirements. METHODS: Three databases (PubMed, EMBASE, and Cochrane library) were searched independently for publications mentioning the use of antifibrinolytics during hip reconstruction surgery in CP children. The primary outcome was to compare the surgical blood loss with and without antifibrinolytics use. Secondary outcomes were transfusion requirements, drop in hemoglobin level, length of hospital stay, and complication rates. RESULTS: All five studies (reporting 478 patients) published on this topic were found eligible based on inclusion criteria and were included for final analysis. Primary outcome: In three of the included studies, antifibrinolytics use resulted in a significant reduction in total blood loss with a mean difference (MD) of -151.05 mL (95% CI -272.30 to -29.80, p = 0.01). In the other two studies although statistically not significant, antifibrinolytics use reduces estimated blood loss (MD: 3.27, 95% CI -21.44 to 14.91, p = 0.72). Secondary outcomes: We observed that in the antifibrinolytics group, there was a reduction in total blood transfusion requirements (OD: 0.70, 95% CI 0.35 to 1.37, p = 0.29), and a drop in haemoglobin level (MD: 0.16, 95% CI -0.62 to 0.30, p = 0.49) but statistically not significant. No adverse effects related directly to antifibrinolytics were noticed in all five studies. CONCLUSION: Only two out of five included studies favored the use of antifibrinolytics in CP children undergoing hip reconstruction. The evidence synthesized on this meta-analysis is also not sufficient enough to support its routine use in this cohort of children for hip reconstruction surgery. High-quality studies with adequate sample size to determine the effective and safe dosage, timing, and cost involved of different antifibrinolytics are the need of the hour. LEVEL OF EVIDENCE: Ⅲ.

Role of Lung Ultrasound in the Detection of Postoperative Pulmonary Complications in Pediatric Patients: A Prospective Observational Study.

OBJECTIVE: To evaluate the incremental benefit of lung ultrasound (LUS) over clinical examination and chest x-rays (CXR) together (clinico-radiologic examination) for the diagnosis of postoperative pulmonary complications (PPC). DESIGN: Prospective observational study. SETTING: Tertiary care center. PARTICIPANTS: One hundred children after corrective congenital cardiac surgery with left-to-right shunts. INTERVENTION: Participants were independently evaluated with clinico-radiologic examination by the treating team, as well as LUS by an investigator at 12, 24, 48, and 72 hours after surgery. After recording the diagnoses, the LUS findings were disclosed to the treating team and a final diagnosis was made. CXR scores and LUS scores were evaluated for their ability to predict PPC. MEASUREMENTS AND MAIN RESULTS: A total of 34 cases of PPCs were observed. Of these, 32 each were detected by clinico-radiologic examination and LUS alone. Addition of LUS improved total number of PPCs detected in the early postoperative period but not in the late postoperative period. Preoperative and early postoperative LUS scores were superior to CXR scores in predicting occurrence of PPC (area under receiver operating characteristics curve [AUROC] 0.920 v 0.732; p < 0.001 preoperatively; AUROC 0.987 v 0.858, p = 0.001 at 12 hours postoperatively). Multivariate analysis suggested LUS score as an independent predictor of PPC, and LUS score along with aortic cross-clamp time as independent predictors of duration of mechanical ventilation and intensive care unit stay. CONCLUSIONS: LUS improves identification of PPC over clinico-radiologic examination in the early postoperative period. Preoperative LUS scores have better predictive ability than CXR scores for the occurrence of PPC.

Pressure support ventilation-pro decreases propofol consumption and improves postoperative oxygenation index compared with pressure-controlled ventilation in children undergoing ambulatory surgery: a randomized controlled trial.

PURPOSE: The PSVPro mode is increasingly being used for surgeries under laryngeal mask airway owing to improved ventilator-patient synchrony and decreased work of breathing. We hypothesized that PSVPro ventilation mode would reduce consumption of anesthetic agents compared with pressure control ventilation (PCV). METHODS: Seventy children between three and eight years of age undergoing elective lower abdominal and urological surgery were randomized into PCV group (n = 35) or PSVPro group (n = 35). General anesthesia was induced with sevoflurane and a Proseal LMA™ was inserted. Anesthesia was maintained with propofol infusion to maintain the entropy values between 40 and 60. In the PCV mode, the inspiratory pressure was adjusted to obtain an expiratory tidal volume of 8 mL·kg-1 and a respiratory rate of 12-20/min. In the PSVPRO group, the flow trigger was set at 0.4 L·min-1 and pressure support was adjusted to obtain expiratory tidal volume of 8 mL·kg-1. Consumption of anesthetic agent was recorded as the primary outcome. Emergence time and discharge time were recorded as secondary outcomes. RESULTS: The PSVPro group showed significant reduction in propofol consumption compared with the PCV group (mean difference, 33.3 µg-1·kg-1·min-1; 95% confidence interval [CI], 24.2 to 42.2). There was decrease in the emergence time in the PSVPro group compared with the PCV group (mean difference, 3.5 min; 95% CI, 2.8 to 4.2) and in time to achieve modified Aldrete score > 9 (mean difference, 3.6 min; 95% CI, 1.9 to 5.2). CONCLUSION: The PSVPro mode decreases propofol consumption and emergence time, and improves oxygenation index in children undergoing ambulatory surgery. TRIAL REGISTRATION: Clinical Trial Registry of India (CTRI/2017/12/010942); registered 21 December, 2017.

Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: A randomized trial.

OBJECTIVES/HYPOTHESIS: The aim of this study was to compare the effect of dexmedetomidine and propofol on airway dynamics, cardiorespiratory system, and emergence following drug-induced sleep endoscopy (DISE). STUDY DESIGN: Prospective, randomized, single-blinded study. METHODS: Sixty patients age 18 to 65 years in American Society of Anesthesiologists physical status groups 1 and 2 scheduled to undergo DISE were randomly allocated to either Group P (N = 30; receiving propofol infusion at 50-150 µg/kg/min) or Group D (N = 30; receiving dexmedetomidine bolus of 1 µg/kg followed by infusion at 0.5-1.0 µg/kg/hr). DISE was done at light sleep and deep sleep. Airway obstruction at tongue base was recorded as primary outcome. Airway obstruction at velum, oropharyngeal lateral wall, and epiglottis level during light and deep sedation, hemodynamic and respiratory parameters, time to attain sufficient sedation, time for emergence from sedation, and any adverse events during DISE with the two study drugs were recorded as secondary outcomes. RESULTS: There was a greater degree of obstruction at the tongue base level (P = 0.001) and Oropharynx level (P = 0.017) in Group P compared with Group D during deep sedation. Increase in airway obstruction from light to deep sleep was seen with propofol at the oropharynx (P = 0.0185) and tongue base (P = 0.0108) levels. Two patients (6.6%) in Group D and 10 patients (33.3%) in Group P showed oxygen saturation below the minimum oxygen saturation recorded during polysomnography. Time to open eyes to call after stopping sedation was significantly less in Group P (P = 0.005). CONCLUSIONS: Dexmedetomidine shows a lesser degree of airway collapse and higher oxygen saturation levels at greater sedation depth during DISE. Propofol has a faster onset and emergence from sedation. LEVEL OF EVIDENCE: 1b Laryngoscope, 130:257-262, 2020.

Incentive-Based Game for Allaying Preoperative Anxiety in Children: A Prospective, Randomized Trial.

BACKGROUND: Induction of anesthesia can be distressing both for children and their parents. Nonpharmacological behavioral interventions can reduce the anxiety of children without significant adverse effects as seen with sedative medications. We hypothesized that the use of incentive-based game therapy in conjunction with parental involvement would be a simple and cost-effective intervention in reducing the preoperative anxiety in children. METHODS: Eighty children between the age group of 4 and 8 years scheduled to undergo surgery were randomly assigned to a control group (n = 40) and intervention group (n = 40). Children in the intervention group participated in an incentive-based game in the preoperative room. Anesthesia was induced with parental presence in both the groups. The modified Yale Preoperative Anxiety Scale (mYPAS) score to measure the anxiety of the children during induction was taken as the primary outcome. Induction Compliance Checklist score and parental satisfaction were assessed as secondary outcomes. RESULTS: The mYPAS score of children in the intervention group was significantly less than the control group during anesthesia induction. The mean difference (95% confidence interval [CI]) of the mYPAS at induction between the 2 groups was 20 (95% CI, 16-24; P < .001). Fourteen (35%) children in the intervention group and 2 (5%) children in control group displayed no anxiety (mYPAS score <30) (difference of -30%; 95% CI, -11% to -49%; P < .001). Children in the intervention group were more compliant with mask induction and had a significantly less Induction Compliance Checklist score compared to the control (P < .001). Thirty (75%) parents in the intervention group were satisfied at the end of surgery compared to 6 (15%) in the control group (difference of -60%; 95% CI, -39% to -73%; P < .001). CONCLUSIONS: The use of incentive-based game therapy reduces the anxiety scores during induction of anesthesia and improves the compliance to facemask induction in children undergoing surgery. It can form a simple, cost-effective, and easy-to-administer technique that can be easily applied in low-income settings.

Comparison of adductor canal block for analgesia in arthroscopic surgery with ropivacaine alone and ropivacaine and clonidine / Comparação do bloqueio do canal adutor para analgesia em cirurgia artroscópica com ropivacaína isolada e ropivacaína + clonidina

Abstract Background and objectives: Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound-guided adductor canal block with ropivacaine alone and ropivacaine with clonidine. Methods: A prospective randomized double blinded study was conducted including sixty-three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S - control group received adductor canal block with 30 mL saline, Group R - ropivacaine group received adductor canal block with 30 mL of 0.375% ropivacaine and Group RC - clonidine group received adductor canal block with 30 mL of 0.375% ropivacaine with clonidine 1 µg.kg-1. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting. Results: The mean pain free periods were 20 min, 384.76 min and 558.09 min for Group S, Group R and Group RC, respectively and this difference was statistically significant (p < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement. Conclusion: Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ.

Resumo Justificativa e objetivos: O alívio inadequado da dor após a reconstrução do ligamento cruzado anterior afeta a mobilidade, leva ao desenvolvimento de aderências, inserção do ligamento enfraquecido e atrofia muscular. O bloqueio do canal adutor para analgesia pós-operatória preserva a força do quadríceps. O presente estudo foi feito para comparar o período sem dor em pacientes de reconstrução artroscópica do ligamento cruzado anterior, submetidos ao bloqueio do canal adutor guiado por ultrassom com ropivacaína isolada e ropivacaína + clonidina. Métodos: Um estudo prospectivo, randômico e duplo-cego foi conduzido com 63 pacientes adultos, estado físico ASA I-II, submetidos à reconstrução do ligamento cruzado anterior. Os pacientes foram randomizados em três grupos: Grupo S, que recebeu bloqueio do canal adutor com 30 mL de solução salina para controle; Grupo R, que recebeu bloqueio do canal adutor com 30 mL de ropivacaína a 0,375%; Grupo RC, que recebeu bloqueio do canal adutor com 30 mL de ropivacaína a 0,375% e 1 µg.kg-1 de clonidina. O desfecho primário do estudo foi comparar o período sem dor nos pacientes que receberam bloqueio do canal adutor com ropivacaína isolada ou ropivacina + clonidina. Os desfechos secundários foram escores de dor em repouso e movimento, necessidade total de analgésicos, escore de sedação, além de náusea e vômito no pós-operatório. Resultados: Os períodos médios sem dor foram 20 min, 384,76 min e 558,09 min para os grupos S, R e RC, respectivamente, e essa diferença foi estatisticamente significativa (p < 0,001). Não houve diferença significativa entre os grupos R e RC em termos de escores de dor em repouso e movimento e a necessidade total de analgésicos. Conclusão: A adição de clonidina à ropivacaína em bloqueio do canal adutor guiado por ultrassom levou a um prolongamento significativo do período sem dor, embora os escores de dor em repouso e movimento, e a necessidade de analgésico de resgate, não tenham diferido.

[Comparison of adductor canal block for analgesia in arthroscopic surgery with ropivacaine alone and ropivacaine and clonidine]. / Comparação do bloqueio do canal adutor para analgesia em cirurgia artroscópica com ropivacaína isolada e ropivacaína + clonidina.

BACKGROUND AND OBJECTIVES: Inadequate pain relief after anterior cruciate ligament reconstruction affects mobility leading to development of adhesions, weakened ligament insertion and muscle atrophy. Adductor canal block for postoperative analgesia preserves quadriceps strength. The present study was conducted to compare pain free period in patients undergoing arthroscopic anterior cruciate ligament reconstruction, receiving ultrasound-guided adductor canal block with ropivacaine alone and ropivacaine with clonidine. METHODS: A prospective randomized double blinded study was conducted including sixty-three adult, ASA class I, II patients undergoing anterior cruciate ligament reconstruction. They were randomized into three groups: Group S - control group received adductor canal block with 30mL saline, Group R - ropivacaine group received adductor canal block with 30mL of 0.375% ropivacaine and Group RC - clonidine group received adductor canal block with 30mL of 0.375% ropivacaine with clonidine 1µg.kg-1. The primary aim was to compare the pain free period in patients receiving adductor canal block with ropivacaine alone or ropivacine with clonidine. The secondary outcomes were pain score at rest and movement, total analgesic requirement, sedation score and postoperative nausea and vomiting. RESULTS: The mean pain free periods were 20min, 384.76min and 558.09min for Group S, Group R and Group RC, respectively and this difference was statistically significant (p < 0.001). There was no significant difference between Group R and Group RC in terms of pain scores at rest and movement and total analgesic requirement. CONCLUSION: Addition of clonidine to ropivacaine in USG guided adductor canal block led to significant prolongation of pain free period though pain score at rest and movement, and rescue analgesic requirement, did not differ.

Changes in airway dimensions after robot assisted surgeries in steep Trendelenburg position.

Robotic surgeries in the extreme Trendelenburg position can lead to changes in the airway dimensions. We conducted a prospective, observational trial to explore the use of ultrasound to quantify these changes in the airway dimensions and identify the factors associated with it. Fifty-two American society of Anaesthesiologists physical status I-II patients between 18 and 70 years of age of either sex scheduled to undergo robot assisted urological procedures in steep Trendelenburg position were enrolled. Anterior soft tissue thickness at the level of hyoid bone and vocal cords, tongue thickness, Malampatti grading and neck circumference were measured at predefined postoperative intervals in the immediate postoperative period, at 2-, 6- and 12-h period postoperatively. Linear stepwise regression analysis was done to explore the factors associated with change in anterior tissue thickness immediately after surgery. The mean difference (95%; CI) in the anterior soft tissue thickness in the immediate postoperative period at the level of hyoid was 0.023 (0.029-0.016) cm, p < 0.001 and at level of vocal cords was - 0.012 (- 0.017 to - 0.008) cm, p < 0.001 from the baseline. There was a significant increase in tongue thickness (0.002), Mallampati score (p = 0.002) and neck circumference (p < 0.001) in immediate postoperative period. The change in anterior tissue thickness at the level of hyoid was affected by total intraoperative fluids used (r = 0.602, p < 0.001), airway trauma (r = 0.275, p = 0.002) and duration of surgery (r = 0.243, p = 0.025). Significant changes in airway dimensions after robotic surgeries in Trendelenburg position persist till 2 h in the postoperative period which warrant vigilant monitoring for any airway compromise during this period.