PERIOPERATIVE AIRWAY EDEMA DUE TO PROLONGED TRENDELENBURG POSITION

Abstract

Airway edema is an uncommon but potentially life-threatening complication following prolonged surgery in the Trendelenburg position, particularly during laparoscopic pelvic procedures. Early recognition and appropriate airway assessment are essential to prevent post-extubation airway compromise. We report the case of a 37-year-old woman who developed clinically significant airway edema following a prolonged laparoscopic total hysterectomy performed in the lithotomy and steep Trendelenburg position. Bilateral conjunctival edema was noted and subsequent negative cuff leak test suggested significant upper airway edema. Extubation was delayed, and the patient was managed with reverse Trendelenburg positioning, intravenous corticosteroids, diuretics, and continued mechanical ventilation. She was successfully extubated later after positive cuff leak test. This case highlights the importance of anticipating airway edema in patients undergoing prolonged laparoscopic pelvic surgery in the Trendelenburg position with conjunctival edema and emphasizes the value of the cuff leak test in guiding safe extubation.