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Steep Trendelenburg Respiratory Effects — FRCA Final MCQ

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ModerateGeneral AnaesthesiaSteep Trendelenburg Respiratory EffectsFRCA Final

A 65-year-old man (ASA III) is scheduled for robotic prostatectomy in steep Trendelenburg position. He has a BMI of 38 and significant gastro-oesophageal reflux. What is the primary respiratory concern in steep Trendelenburg?

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Correct answer: B — Decreased functional residual capacity and atelectasis with increased airway pressures

Steep Trendelenburg position (typically 30-45° head-down) combined with pneumoperitoneum causes significant cephalad displacement of the diaphragm, reducing FRC, promoting atelectasis, and increasing peak and plateau airway pressures. In obese patients this effect is magnified. Ventilation strategy should include lung-protective volumes (6-8 mL/kg IBW), adequate PEEP (8-12 cmH2O), recruitment manoeuvres, and avoidance of high plateau pressures (>30 cmH2O). Aspiration risk is increased in steep Trendelenburg especially with reflux and obesity.

Reference: RCOA – 2023 – Robotic surgery anaesthesia; AAGBI – 2020 – Laparoscopic surgery