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Facial Oedema Steep Trendelenburg — FRCA Final MCQ

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ModerateGeneral AnaesthesiaFacial Oedema Steep TrendelenburgFRCA Final

A 45-year-old man (ASA I) undergoes a robotic prostatectomy in steep Trendelenburg. After 4 hours, the surgical team asks to convert to open. Post-extubation the patient has bilateral chemosis (conjunctival oedema), facial oedema, and tongue swelling. What is the cause?

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Correct answer: D — Venous congestion from prolonged steep Trendelenburg position

Prolonged steep Trendelenburg position causes gravitational venous congestion of the head, neck, and upper body. This leads to facial, periorbital, conjunctival (chemosis), and oropharyngeal oedema. In severe cases, airway oedema can cause post-extubation stridor and airway compromise. A cuff leak test should be performed before extubation. If significant oedema is present, delayed extubation may be necessary. Risk factors include: duration >4 hours, large volume fluid administration, and pre-existing venous drainage impairment.

Reference: RCOA – 2023 – Robotic surgery; AAGBI – 2020 – Laparoscopic positioning complications