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Kılınç E, Yildirim SA, Ulugöl H, Büyüköner EE, Güçyetmez B, Toraman F. The evaluation of cardiac functions in deep Trendelenburg position during robotic-assisted laparoscopic prostatectomy. Front Med (Lausanne) 2023; 10:1273180. [PMID: 37822468 PMCID: PMC10563763 DOI: 10.3389/fmed.2023.1273180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Objective This study aimed to demonstrate the reliability of the cardiac cycle efficiency value through its correlation with longitudinal strain by observing the effect of the deep Trendelenburg position. Design A prospective, observational study. Setting Single center. Participants Between May and September 2022, the hemodynamic parameters of 30 patients who underwent robotic assisted laparoscopic prostatectomy under general anesthesia were prospectively evaluated. Measurements and main results All invasive cardiac monitoring parameters and longitudinal strain achieved transesophageal echocardiography were recorded in pre-deep Trendelenburg position (T3) and 10th minute of deep Trendelenburg position (T4). Delta values were calculated for the cardiac cycle efficiency and longitudinal strain (values at T4 minus values at T3). The estimated power was calculated as 0.99 in accordance with the cardiac cycle efficiency values at T3 and T4 (effect size: 0.85 standard deviations of the mean difference: 0.22, alpha: 0.05). At T4, heart rate, pulse pressure variation, cardiac cycle efficiency, dP/dt and longitudinal strain were significantly lower than those at T3 (p = 0.009, p < 0.001, p < 0.001, and p < 0.001, respectively). There was a positive correlation between the delta-cardiac cycle efficiency and delta-longitudinal strain (R2 = 0.36, p < 0.001). Conclusion Although the absence of significant changes in mean arterial pressure and cardiac index after Trendelenburg position suggests that cardiac workload has not changed, changes in cardiac cycle efficiency and longitudinal strain indicate increased cardiac workload due to increased ventriculo-arterial coupling.
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Affiliation(s)
- Emir Kılınç
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Serap Aktas Yildirim
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Halim Ulugöl
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Elif Eroğlu Büyüköner
- Department of Cardiology, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Bülent Güçyetmez
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
| | - Fevzi Toraman
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Acibadem University, Istanbul, Türkiye
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Hernandez-Meza G, Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy: an update. Minerva Anestesiol 2023; 89:812-823. [PMID: 37158629 DOI: 10.23736/s0375-9393.23.17284-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, ocular, respiratory, and hemodynamic homeostasis. Possible non-surgical complications range from mild subcutaneous emphysema to devastating ischemic optic neuropathy. The anesthetic management of RALP patients involves a thorough preoperative evaluation, careful positioning on the operative table, managing ventilation issues, and appropriate fluid management. Close coordination between the anesthesia and surgical teams is required for a successful surgery. This updated review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP.
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Affiliation(s)
- Gabriela Hernandez-Meza
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, NY, USA
| | - Daniel M Gainsburg
- Department of Anesthesiology, Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, NY, USA -
- Department of Urology, Icahn School of Medicine at Mount Sinai, The Mount Sinai Medical Center, New York, NY, USA
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Atasever AG, Salviz EA, Şentürk Çiftçi H, Bingül ES, Sivrikoz N, Erdem S, Savran Karadeniz M. The Effects of Lateral 45° Head-Down Position and Carbon Dioxide Pneumoperitoneum on the Optic Nerve Sheath Diameter in Patients Undergoing Laparoscopic Transperitoneal Nephrectomies: A Prospective Observational Study. J Laparoendosc Adv Surg Tech A 2023; 33:171-176. [PMID: 36036829 DOI: 10.1089/lap.2022.0344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The aim of this study is to assess the extent of the increased intracranial pressure resulting from lateral decubitus and 45° downward positioning using sonographic optic nerve sheath diameter (ONSD) in patients undergoing laparoscopic transperitoneal nephrectomy. In addition, we evaluated the effect of the carbon dioxide pneumoperitoneum (CO2PP) on ONSD. Materials and Methods: Twenty-four adults were enrolled in this prospective observational study. Longitudinal and transverse ONSDs were measured for each eye by ocular ultrasonography. The values were noted in supine position (T0), 20 minutes after induction of anesthesia (T1), after insufflation of the abdomen in lateral 45° head-down position (T2), at 30-minute intervals during surgery (T3-T4-T5), during lateral 45° head-down position after CO2 exsufflation (T6), before awakening while supine (T7), and at postoperative 24th hour (T8). Hemodynamic and respiratory parameters were investigated at the measurement time points. Results: Average ONSD values for the lower eye was T0 = 4.27 ± 0.4 mm, T1 = 4.56 ± 0.6 mm, T2 = 4.84 ± 0.6 mm, T3 = 4.91 ± 0.4 mm, T4 = 4.99 ± 0.5 mm, T5 = 4.97 ± 0.5 mm T6 = 4.96 ± 0.5 mm, T7 = 4.76 ± 0.4 mm, T8 = 4.36 ± 0.5 mm and for the upper eye was T0 = 4.24 ± 0.4 mm, T1 = 4.39 ± 0.5 mm, T2 = 4.54 ± 0.5 mm, T3 = 4.60 ± 0.4 mm, T4 = 4.66 ± 0.4 mm, T5 = 4.72 ± 0.7 mm, T6 = 4.68 ± 0.4 mm, T7 = 4.52 ± 0.4 mm, T8 = 4.30 ± 0.4 mm (P < .001). Conclusion: In our study, we observed a significant increase in ONSD within minutes after the patient was placed in a head-down position. We also observed that the difference increased more with CO2PP and was proportional to the length of the surgery. We found that it regressed to initial levels at the postoperative 24th hour. Clinicaltrials.gov: NCT05185908.
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Affiliation(s)
- Ayşe Gülşah Atasever
- Department of Anesthesiology and Intensive Care, Gaziosmanpasa Research and Training Hospital, Istanbul, Turkey
| | - Emine Aysu Salviz
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hayriye Şentürk Çiftçi
- Department of Medical Biology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Emre Sertaç Bingül
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Nükhet Sivrikoz
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Selcuk Erdem
- Division of Urologic Oncology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Meltem Savran Karadeniz
- Department of Anesthesiology and Reanimation, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
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4
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Robotic assited perineal prostatectomy (RAPP) as a new era for anesthesiology: It’s effects on hemodynamic parameters and respiratory mechanics. J Robot Surg 2022; 17:933-940. [DOI: 10.1007/s11701-022-01482-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022]
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5
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Chung YH, Jeong YS, Martin GL, Choi MS, Kang YJ, Lee M, Cho A, Koo BS, Cho SH, Kim SH. Prediction of blood pressure changes associated with abdominal pressure changes during robotic laparoscopic low abdominal surgery using deep learning. PLoS One 2022; 17:e0269468. [PMID: 35666742 PMCID: PMC9200233 DOI: 10.1371/journal.pone.0269468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Intraoperative hypertension and blood pressure (BP) fluctuation are known to
be associated with negative patient outcomes. During robotic lower abdominal
surgery, the patient’s abdominal cavity is filled with CO2, and
the patient’s head is steeply positioned toward the floor (Trendelenburg
position). Pneumoperitoneum and the Trendelenburg position together with
physiological alterations during anesthesia, interfere with predicting BP
changes. Recently, deep learning using recurrent neural networks (RNN) was
shown to be effective in predicting intraoperative BP. A model for
predicting BP rise was designed using RNN under special scenarios during
robotic laparoscopic surgery and its accuracy was tested. Methods Databases that included adult patients (over 19 years old) undergoing low
abdominal da Vinci robotic surgery (ovarian cystectomy, hysterectomy,
myomectomy, prostatectomy, and salpingo-oophorectomy) at Soonchunhyang
University Bucheon Hospital from October 2018 to March 2021 were used. An
RNN-based model was designed using Python3 language with the PyTorch
packages. The model was trained to predict whether hypertension (20%
increase in the mean BP from baseline) would develop within 10 minutes after
pneumoperitoneum. Results Eight distinct datasets were generated and the predictive power was compared.
The macro-average F1 scores of the datasets ranged from 68.18% to 72.33%. It
took only 3.472 milliseconds to obtain 39 prediction outputs. Conclusions A prediction model using the RNN may predict BP rises during robotic
laparoscopic surgery.
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Affiliation(s)
- Yang-Hoon Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Young-Seob Jeong
- Department of Computer Engineering, Chungbuk National University,
Cheongju, Republic of Korea
| | - Gati Lother Martin
- Department of ICT Convergence, Soonchunhyang University, Asan-si,
Republic of Korea
| | - Min Seo Choi
- Industry-Academy Cooperation Foundation, Soonchunhyang University,
Asan-si, Republic of Korea
| | - You Jin Kang
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Misoon Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Ana Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Bon Sung Koo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Sung Hwan Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
| | - Sang Hyun Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University
Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Republic of Korea
- * E-mail:
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Nakazawa K, Kodaira A, Matsumoto R, Matsushita T, Yoshikawa R, Ishida Y, Uchino H. Positive end-expiratory pressure setting based on transpulmonary pressure during robot-assisted laparoscopic prostatectomy: an observational intervention study. JA Clin Rep 2022; 8:10. [PMID: 35150377 PMCID: PMC8840948 DOI: 10.1186/s40981-022-00501-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/22/2022] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background In robot-assisted laparoscopic prostatectomy (RALP), concerns include the formation of atelectasis and reduced functional residual capacity. The present study aimed to examine the feasibility of positive end-expiratory pressure (PEEP) setting based on transpulmonary pressure (Ptp) as well as the effects of incremental PEEP on respiratory mechanics, blood gases, cerebral oxygenation (rSO2), and hemodynamics. Methods Fourteen male patients who were scheduled to receive RALP were recruited. Patients received mechanical ventilation (tidal volume of 6 mL kg−1) and were placed in Trendelenburg position with positive-pressure capnoperitoneum. PEEP levels were increased from 0 to 15 cmH2O (5 cmH2O per increase) every 30 min. PEEP levels were assessed where end-expiratory Ptp levels of ≥0 cmH2O were achieved (PtpEEP0). Airway pressure, esophageal pressure, cardiac index, and blood gas and rSO2 values were measured after 30 min at each PEEP step and respiratory mechanics were calculated. Results With increasing PEEP levels from 0 to 15 cmH2O or PtpEEP0, the values of PaO2 and respiratory system compliance increased, and the values of driving pressure decreased. The median PEEP level associated with PtpEEP0 was 15 cmH2O. Respiratory system compliance values were higher at PtpEEP0 than those at PEEP5 (P = 0.02). Driving pressure was significantly lower at PtpEEP0 than at PEEP5 (P = 0.0036). The cardiac index remained unchanged, and the values of rSO2 were higher at PtpEEP0 than at PEEP0 (right; P = 0.0019, left; P = 0.036). Conclusions PEEP setting determined by transpulmonary pressure can help achieve higher respiratory system compliance values and lower driving pressure without disturbing hemodynamic parameters.
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Affiliation(s)
- Koichi Nakazawa
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan.
| | - Ami Kodaira
- Department of Anesthesia, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Rika Matsumoto
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Tomoko Matsushita
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Ryotaro Yoshikawa
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Yusuke Ishida
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
| | - Hiroyuki Uchino
- Department of Anesthesia, Tokyo Medical University Hospital, 6-7-1 Nishishinjyuku, Shinjyuku-ku, Tokyo, 1600023, Japan
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7
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Yu J, Park JY, Hong JH, Hwang JH, Kim YK. Effect of pneumoperitoneum and Trendelenburg position on internal carotid artery blood flow measured by ultrasound during robotic prostatectomy. Clin Physiol Funct Imaging 2022; 42:139-145. [PMID: 35018713 DOI: 10.1111/cpf.12742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Robotic prostatectomy requires pneumoperitoneum and a steep Trendelenburg position; however, this condition may compromise cerebral blood flow. Here, we evaluated the effect of pneumoperitoneum and the steep Trendelenburg position on internal carotid artery (ICA) blood flow measured by Doppler ultrasound during robotic prostatectomy. METHODS Patients who underwent robotic prostatectomy were prospectively recruited. The ICA blood flow was measured at the following five time-points: with the patient awake and in the supine position (Ta), 10 min after anaesthetic induction in the supine position (T1), 10 (T2) and 30 (T3) min after pneumoperitoneum in the steep Trendelenburg position, and at the end of surgery in the supine position after desufflation of the pneumoperitoneum (T4). Hemodynamic and cerebrovascular variables were measured at each time-point. RESULTS A total of 28 patients were evaluated. The ICA blood flows were significantly lower at T2 and T3 than at T1 (162.3±44.7 [T2] vs. 188.0±49.6 mL/min [T1], P=0.002; 163.1±39.9 [T3] vs. 188.0±49.6 mL/min [T1], P=0.009). The ICA blood flow also differed significantly between Ta and T1 (236.8±58.3 vs. 188.0±49.6 mL/min, P<0.001). Heart rates, cardiac indexes, peak systolic velocity, and end-diastolic velocity were significantly lower at T2 and T3 than at T1. However, ICA diameter, mean blood pressure, and end-tidal carbon dioxide partial pressure did not differ significantly at all time-points. CONCLUSION Pneumoperitoneum and the steep Trendelenburg position caused decreased ICA blood flow, suggesting that they should be carefully performed during robotic prostatectomy, especially in patients at risk of postoperative cerebrovascular accident. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jihion Yu
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Young Park
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jai-Hyun Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Kug Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sayed NH, Elaziz MSA, Elkholy AS, Taeimah MO. Effect of inverse ratio ventilation on hemodynamics and respiratory mechanics in obese patients undergoing laparoscopic sleeve gastrectomy. AIN-SHAMS JOURNAL OF ANESTHESIOLOGY 2021. [PMCID: PMC8042839 DOI: 10.1186/s42077-021-00152-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Obesity has become a global epidemic problem affecting every system and is associated with many consequences including coronary artery disease, hypertension, diabetes mellitus, dyslipidemia, obstructive sleep apnea, and socioeconomic and psychosocial impairment. Laparoscopic sleeve gastrectomy is one of the best and most commonly done operations for weight loss. Elevated peak airway pressure and hypoxemia are common problems that anesthesiologists face during laparoscopic surgeries with conventional volume-controlled ventilation. This study aimed at the use of the prolonged I:E ratio as an alternative strategy to improve gas exchange and the respiratory mechanics of obese patients undergoing laparoscopic sleeve gastrectomy. Results The study was a prospective randomized controlled trial and was performed between April 2019 and March 2020. After the approval of the departmental ethical committee and the informed written consent had been taken from the patients, fifty-two obese patients undergoing laparoscopic sleeve gastrectomy were enrolled in this study. After endotracheal intubation, the patients were randomly divided into the IRV group (n=26) and the VCV group (n=26). Respiratory parameters were adjusted as tidal volume (Vt) 8mL/kg ideal body weight, respiratory rate 12 breaths/min, positive-end expiratory pressure (PEEP) 0, fractional inspired oxygen (FiO2) 0.6, and I:E ratio 1:2 for the VCV group and 2:1 for the IRV group; hemodynamics and respiratory mechanics were monitored and recorded after intubation (0 min), before pneumoperitoneum (10 mins), and after pneumoperitoneum (20 mins), 30, 40, 50, and 60 mins. IRV significantly improves the respiratory mechanics during pneumoperitoneum in the form of decreasing the peak pressure (Ppeak) and plateau pressure (Pplat) and improving the dynamic compliance, but the mean pressure (Pmean) was increased; it also increased the partial pressure of oxygen (arterial PO2) significantly. No statistical significance was found regarding the demographic data or the hemodynamics. Conclusion IRV is superior to conventional VCV in morbidly obese patients undergoing laparoscopic sleeve gastrectomy as it improves respiratory mechanics and oxygenation.
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Zhang W, Yin D, Chen X, Zhang S, Meng F, Guo H, Liang S, Zhou S, Liu S, Sun L, Guo X, Luo H, He B, Xiao D, Cai W, Fang C, Liu L, Jia F. Morphologic Change of In Vivo Porcine Liver Under 13 mm Hg Pneumoperitoneum Pressure. Surg Laparosc Endosc Percutan Tech 2021; 31:679-684. [PMID: 34420005 DOI: 10.1097/sle.0000000000000973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinically, the total and residual liver volume must be accurately calculated before major hepatectomy. However, liver volume might be influenced by pneumoperitoneum during surgery. Changes in liver volume change also affect the accuracy of simulation and augmented reality navigation systems, which are commonly first validated in animal models. In this study, the morphologic changes in porcine livers in vivo under 13 mm Hg pneumoperitoneum pressure were investigated. MATERIALS AND METHODS Twenty male pigs were scanned with contrast-enhanced computed tomography without pneumoperitoneum and with 13 mm Hg pneumoperitoneum pressure. RESULTS The surface area and volume of the liver and the vascular diameter of the aortic lumen, inferior vena cava lumen, and portal vein lumen were measured. There were statistically significant differences in the surface area and volume of the liver (P=0.000), transverse diameter of the portal vein (P=0.038), longitudinal diameter of the inferior vena cava (P=0.033), longitudinal diameter of the portal vein (P=0.036), vascular cross-sectional area of the inferior vena cava (P=0.028), and portal vein (P=0.038) before and after 13 mm Hg pneumoperitoneum pressure. CONCLUSIONS This study indicated that the creation of pneumoperitoneum at 13 mm Hg pressure in a porcine causes liver morphologic alterations affecting the area and volume, as well as the diameter of a blood vessel.
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Affiliation(s)
- Wenyu Zhang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences
- Department of Surgery, Shenzhen Second People's Hospital, Shenzhen
| | - Dalong Yin
- Department of General Surgery, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Xiaoxia Chen
- Department of Radiology, The Third Medical Center, Chinese PLA General Hospital, Beijing
| | - Shugeng Zhang
- Department of General Surgery, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Fanzheng Meng
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Hongrui Guo
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Shuhang Liang
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Shuo Zhou
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Shuxun Liu
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Linmao Sun
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Xiao Guo
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Huoling Luo
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences
| | - Baochun He
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences
| | - Deqiang Xiao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences
| | - Wei Cai
- Department of Hepatic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University
| | - Lianxin Liu
- Department of Surgery, Shenzhen Second People's Hospital, Shenzhen
- Department of General Surgery, The First Affiliated Hospital, Division of Life Sciences and Medicine, University of Science and Technology
| | - Fucang Jia
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences
- Pazhou Lab, Guangzhou, China
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Fukada T, Tsuchiya Y, Iwakiri H, Ozaki M, Nomura M. Forehead Regional Oxygen Saturation (rSO2)-Related Ear-Level Arterial Pressure and Lower Thigh rSO2 in the Steep Trendelenburg Position with CO2 Pneumoperitoneum and the Beach Chair Position. Cureus 2021; 13:e15687. [PMID: 34277276 PMCID: PMC8284083 DOI: 10.7759/cureus.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Regional oxygen saturation (rSO2) reflects tissue perfusion. This observational study aimed to examine the change in the forehead and lower thigh rSO2 associated with intraoperative posture, anesthesia regimen, or mean arterial pressure (mAP) at heart and external auditory meatus (ear) levels. Methods Patients undergoing robot-assisted laparoscopic radical prostatectomy in the Trendelenburg position at 30° with pneumoperitoneum (TPP) or arthroscopic shoulder surgery in the beach chair position at 70° (BCP) under desflurane-remifentanil (D/R) or propofol-remifentanil (P/R) anesthesia were examined. Bilateral forehead and lower thigh rSO2 values and mean radial artery pressure were measured simultaneously at heart and ear levels. Results In TPP, there were no differences under anesthesia regimens in the forehead or lower thigh rSO2change, although one patient with an absolute lower thigh rSO2 of ≤50% in the lithotomy position complained of transient limb pain. No correlation was observed between rSO2 and mAP. In BCP, forehead rSO2 decreased and lower thigh rSO2 increased under either of the anesthesia regimens. The coefficient of correlation between forehead rSO2 andheart-level and ear-level mAP was 0.341 and 0.236, respectively. Conclusions There were no differences under anesthesia regimens in the changes of forehead rSO2 and lower thigh rSO2. In TPP, significant changes in forehead rSO2 and lower thigh rSO2 were not observed. Monitoring lower thigh rSO2 might be useful for preventing lower extremity pain. In BCP, forehead rSO2 decreased and lower thigh rSO2 increased from the supine position to the BCP. To prevent brain damage, anesthesiologists should pay attention to heart- and ear-level mAP.
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Affiliation(s)
- Tomoko Fukada
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Yuri Tsuchiya
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Hiroko Iwakiri
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Minoru Nomura
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
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Kim HY, Lee SY, Lee HS, Jun BK, Choi JB, Kim JE. Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial. Adv Ther 2021; 38:1701-1712. [PMID: 33611742 DOI: 10.1007/s12325-021-01643-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/29/2021] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Robotic radical prostatectomy requires prolonged pneumoperitoneum and a steep Trendelenburg position. Magnesium can attenuate the stress response and hemodynamic perturbations. This study aimed to evaluate the effects of intravenous magnesium administration on hemodynamics and the stress response in patients undergoing robotic radical prostatectomy. METHODS In this prospective, double-blind, randomized controlled study, 52 patients undergoing robotic radical prostatectomy were randomized into two groups: 26 in the magnesium group and 26 in the control group. The patients in the magnesium group received magnesium sulfate 50 mg/kg intravenously, followed by infusion at a rate of 10 mg/kg/h during surgery. The patients in the control group received an equal volume of 0.9% saline. The primary outcomes were the changes in heart rate and mean arterial pressure (MAP) during surgery. The serum stress hormones (adrenocorticotropic hormone, cortisol, epinephrine, and norepinephrine) were also measured. RESULTS MAP showed a significant intergroup difference over time (Pgroup*time = 0.017); it increased significantly at 5 min after Trendelenburg position in the control group and decreased significantly at 30 min after Trendelenburg position in the magnesium group. The intergroup difference in the change in cortisol concentrations was significant over time (Pgroup*time = 0.006). The cortisol concentration decreased significantly from baseline to 24 h after surgery in the magnesium group but did not change significantly in the control group. The requirement for intraoperative remifentanil was 35% lower in the magnesium group (P = 0.011), and the severity of postoperative pain at 30 min and 6 h after surgery was also lower in the magnesium group (P = 0.024 and P = 0.015). CONCLUSION There is a possibility that intravenous magnesium administration during robotic radical prostatectomy reduces the increases in arterial pressure, cortisol concentrations, opioid requirements, and postoperative pain. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT02833038.
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Affiliation(s)
- Ha Yeon Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Sook Young Lee
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Bo Kyeong Jun
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Jong Bum Choi
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea
| | - Ji Eun Kim
- Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon, South Korea.
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Pisansky AJB, Burbano-Vera N, Stopfkuchen-Evans MF. Anesthetic management of a patient with left ventricular assist device undergoing robotic laparoscopic prostatectomy: a case report. JA Clin Rep 2020; 6:57. [PMID: 32712732 PMCID: PMC7382672 DOI: 10.1186/s40981-020-00364-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Patients with left ventricular assist devices (LVAD) require specific anesthetic and hemodynamic considerations. We report the specific anesthetic preparation and management in this scenario. Case presentation We present the case of a 66-year-old male with a HeartMate II LVAD undergoing robotic prostatectomy for prostate cancer in the steep Trendelenburg position. We employed central venous and radial arterial access, LVAD pump parameters, near-infrared sensor of cerebral oximetry, and transesophageal echocardiography for monitoring. Hemodynamics were managed with nicardipine, dobutamine, epinephrine, and phenylephrine during abdominal insufflation, operative positioning, and desufflation. The patient had a successful procedure, was discharged on postoperative day 2, and achieved surgical cure of his prostate cancer. Discussion By presenting the first detailed account of anesthetic management in this scenario, we provide a clinical vignette for use by the clinical anesthesiologist in his or her preparation prior to caring for this type of patient.
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13
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Measuring organ shift and deformation for port placement in robot-assisted minimally invasive surgery. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2020. [DOI: 10.1016/j.lers.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Pawlik MT, Prasser C, Zeman F, Harth M, Burger M, Denzinger S, Blecha S. Pronounced haemodynamic changes during and after robotic-assisted laparoscopic prostatectomy: a prospective observational study. BMJ Open 2020; 10:e038045. [PMID: 33020097 PMCID: PMC7537432 DOI: 10.1136/bmjopen-2020-038045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Robotic-assisted laparoscopic prostatectomy (RALP) is typically conducted in steep Trendelenburg position (STP). This study investigated the influence of permanent 45° STP and capnoperitoneum on haemodynamic parameters during and after RALP. DESIGN Prospective observational study. SETTING Haemodynamic changes were recorded with transpulmonary thermodilution and pulse contour analysis in men undergoing RALP under standardised anaesthesia. PARTICIPANTS Informed consent was obtained from 51 patients scheduled for elective RALP in a University Medical Centre in Germany. INTERVENTIONS Heart rate, mean arterial pressure, central venous pressure (CVP), Cardiac Index (CI), systemic vascular resistance (SVR), Global End-Diastolic Volume Index (GEDI), global ejection fraction (GEF), Cardiac Power Index (CPI) and stroke volume variation (SVV) were recorded at six time points: 20 min after induction of anaesthesia (T1), after insufflation of capnoperitoneum in supine position (T2), after 30 min in STP (T3), when controlling Santorini's plexus in STP (T4), before awakening in supine position (T5) and after 45 min in the recovery room (T6). Adverse cardiac events were registered intraoperatively and postoperatively. RESULTS All haemodynamic parameters were significantly changed by capnoperitoneum and STP during RALP and partly normalised at T6. CI, GEF and CPI were highest at T6 (CI: 3.9 vs 2.2 L/min/m²; GEF: 26 vs 22%; CPI: 0.80 vs 0.39 W/m²; p<0.001). CVP was highest at T4 (31 vs 7 mm Hg, p<0.001) and GEDI at T6 (819 vs 724 mL/m², p=0.005). Mean SVR initially increased (T2) but had decreased by 24% at T6 (p<0.001). SVV was highest at T5 (12 vs 9%, p<0.001). Two of the patients developed cardiac arrhythmia during RALP and one patient suffered postoperative cardiac ischaemia. CONCLUSIONS RALP led to pronounced perioperative haemodynamic changes. The combination of increased cardiac contractility and heart rate reflects a hyperdynamic situation during and after RALP. Anaesthesiologists should be aware of unnoticed pre-existing heart failure to worsen during STP in patients undergoing RALP.
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Affiliation(s)
- Michael T Pawlik
- Department of Anaesthesiology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Bayern, Germany
| | - Christopher Prasser
- Department of Anaesthesiology, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Florian Zeman
- Centre for Clinical Studies, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
| | - Marion Harth
- Department of Anaesthesiology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Bayern, Germany
| | - Maximilian Burger
- Department of Urology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas-Krankenhaus Sankt Josef Regensburg, Regensburg, Germany
| | - Sebastian Blecha
- Department of Anaesthesiology, Universitätsklinikum Regensburg, Regensburg, Bayern, Germany
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15
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Aggarwal D, Bora GS, Mavuduru RS, Jangra K, Sharma AP, Gupta S, Devana SK, Parmar K, Kumar S, Mete UK, Singh SK. Robot-assisted pelvic urologic surgeries: is it feasible to perform under reduced tilt? J Robot Surg 2020; 15:553-559. [PMID: 32803652 DOI: 10.1007/s11701-020-01139-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
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16
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Çiçek MÇ, Kaynak Y, Günseren KÖ, Kaygısız O, Vuruşkan H. The effects of laparoscopic urologic surgery on cardiac functions: A pulse wave velocity study. Turk J Urol 2020; 46:1-5. [PMID: 32053098 PMCID: PMC6944419 DOI: 10.5152/tud.2020.19094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study is to evaluate the effects of laparoscopic urologic surgery on cardiac functions by the parameter pulse wave velocity (PWV), a noninvasive method. MATERIAL AND METHODS Between July 2012 and February 2013, a total of 47 patients were included in this prospective controlled study. Patients who have been scheduled for laparoscopic surgery (LS) (n=30) and open surgery (n=17) were enrolled in the study. Preoperative, perioperative, and postoperative cardiovascular parameters were measured by a PWV instrument, and the results were compared between laparoscopic (L) group and open (C) group. RESULTS In the L group, compared to preoperative values, perioperative systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure increased considerably, by 2.6%, 7.9%, and 4.7%, respectively. This was in contrary to reductions in these parameters by 9.5%, 5.7%, and 10%, respectively, in the C group. For the L group, cardiac output (CO) and cardiac index (CI) were increased in the perioperative period and decreased in the postoperative period. For the C group, there were no changes in measurements of perioperative and postoperative CO and CI. However, these changes in CO and CI were not significantly different between the L and C groups. Postoperative large artery elasticity index decreased in both groups. However, these changes did not represent significant difference between groups. CONCLUSION Compared to open surgery, LS may cause increases in perioperative blood pressures. In addition, increased blood pressures may last even on the first postoperative day. These effects may be more important for patients with high cardiovascular risk.
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Affiliation(s)
| | - Yurdaer Kaynak
- Department of Urology, Eskişehir Ümit Hospital, Eskişehir, Turkey
| | | | - Onur Kaygısız
- Department of Urology, Uludağ University School of Medicine, Bursa, Turkey
| | - Hakan Vuruşkan
- Department of Urology, Uludağ University School of Medicine, Bursa, Turkey
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17
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Koo CH, Ryu JH. Anesthetic considerations for urologic surgeries. Korean J Anesthesiol 2019; 73:92-102. [PMID: 31842248 PMCID: PMC7113163 DOI: 10.4097/kja.19437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/15/2019] [Indexed: 12/17/2022] Open
Abstract
Urologic surgeries are widely performed, and the cases have increased owing to the fact that the elderly population is growing. The narrow and limited surgical space is a challenge in performing most urologic surgeries. Additionally, the elderly population is exposed to the risk of perioperative complications; therefore, a comprehensive understanding and approach are required to provide optimized anesthesia during surgery. We have searched the literature on anesthesia for urologic surgeries and summarized the anesthetic considerations for urologic surgeries.
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Affiliation(s)
- Chang-Hoon Koo
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung-Hee Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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18
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Zeuzem-Lampert C, Groene P, Brummer V, Hofmann-Kiefer K. [Cardiorespiratory effects of perioperative positioning techniques]. Anaesthesist 2019; 68:805-813. [PMID: 31713665 DOI: 10.1007/s00101-019-00674-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The supine position is still the most frequently used type of positioning during surgical procedures. Positions other than the supine position lead to physiological alterations that have a relevant influence on the course of anesthesia and surgery. As a matter of principle, hemodynamic stability is at risk because venous blood is pooled in the lower positioned body parts. In addition, head down positions (Trendelenburg position) may lead to an impairment of respiratory function by reducing lung volumes as well as lung compliance. Upright positions (beach chair position) are characterized by a relative hypovolemia accompanied by a reduction of mean arterial pressure, cardiac output and stroke volume, whereas pulmonary functions remain unchanged. Some severe adverse events have been described in the literature (e.g. intraoperative apoplexy, postoperative blindness). The pathophysiological principles and effects of hemodynamic alterations as well as potential strategies to avoid complications are presented and discussed in this lead article. Head down positions, especially the Trendelenburg position, cause a relative (intrathoracic) hypervolemia and an increase in cardiac preload that is usually well-tolerated in patients without heart problems; however, the Trendelenburg position, especially if combined with a capnoperitoneum, significantly impairs pulmonary function, can have a negative effect on intracerebral pressure and may reduce blood flow of intra-abdominal organs. The pathophysiological intraoperative changes caused by Trendelenburg positioning are described and approaches suitable for risk reduction are discussed. The prone position and lateral decubitus position have little influence on the intraoperative homeostasis. Nevertheless, there is an ongoing discussion concerning the efficacy of a 15° left lateral position during caesarean section, which is also discussed in a separate section of this review.
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Affiliation(s)
- C Zeuzem-Lampert
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - P Groene
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - V Brummer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland
| | - K Hofmann-Kiefer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Nussbaumstr. 20, 80336, München, Deutschland.
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19
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Abbas DN, Kamal JM, El Sheikh SM, Mahmod AM. Early experience in anesthesia of robot assisted cystoprostatectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2012.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Dina N. Abbas
- Department of Anesthesia and Pain Management, NCI, Cairo University, Egypt
| | - Jehan M. Kamal
- Department of Anesthesia and Pain Management, NCI, Cairo University, Egypt
| | - Somia M. El Sheikh
- Department of Anesthesia and Pain Management, NCI, Cairo University, Egypt
| | - Ahmed M. Mahmod
- Department of Surgical Oncology, NCI, Cairo University, Egypt
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20
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Aceto P, Beretta L, Cariello C, Claroni C, Esposito C, Forastiere EM, Guarracino F, Perucca R, Romagnoli S, Sollazzi L, Cela V, Ercoli A, Scambia G, Vizza E, Ludovico GM, Sacco E, Vespasiani G, Scudeller L, Corcione A. Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU. Minerva Anestesiol 2019; 85:871-885. [PMID: 30938121 DOI: 10.23736/s0375-9393.19.13360-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Proper management of patients undergoing robotic-assisted urologic and gynecologic surgery must consider a series of peculiarities in the procedures for anesthesiology, critical care medicine, respiratory care, and pain management. Although the indications for robotic-assisted urogynecologic surgeries have increased in recent years, specific guidance documents are still lacking. EVIDENCE ACQUISITION A multidisciplinary group including anesthesiologists, gynecologists, urologists, and a clinical epidemiologist systematically reviewed the relevant literature and provided a set of recommendations and unmet needs on peculiar aspects of anesthesia in this field. EVIDENCE SYNTHESIS Nine core contents were identified, according to their requirements in urogynecologic robotic-assisted surgery: patient position, pneumoperitoneum and ventilation strategies, hemodynamic variations and fluid therapy, neuromuscular block, renal surgery and prevention of acute kidney injury, monitoring the Department of anesthesia, postoperative delirium and cognitive dysfunction, prevention of postoperative nausea and vomiting, and pain management in endometriosis. CONCLUSIONS This consensus document provides guidance for the management of urologic and gynecologic patients scheduled for robotic-assisted surgery. Moreover, the identified unmet needs highlight the requirement for further prospective randomized studies.
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Affiliation(s)
- Paola Aceto
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Luigi Beretta
- Unit of Anesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Cariello
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Claudia Claroni
- Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Clelia Esposito
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Ester M Forastiere
- Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Raffaella Perucca
- Department of Anesthesia and Intensive Care, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Romagnoli
- Section of Anesthesia and Critical Care, Health Science Department, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi Hospital, Florence, Italy
| | - Liliana Sollazzi
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Vito Cela
- Department of Clinical and Experimental Medicine, Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, Amedeo Avogadro University of Eastern Piedmont, Maggiore Hospital, Novara, Italy
| | - Giovanni Scambia
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Enrico Vizza
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe M Ludovico
- Department of Urology, F. Miulli Regional Hospital, Acquavivadelle Fonti, Bari, Italy
| | - Emilio Sacco
- Department of Urology, Sacred Heart Catholic University, A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy
| | - Giuseppe Vespasiani
- Department of Experimental Medicine and Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, San Matteo IRCSS Foundation, Pavia, Italy -
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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21
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Adverse events related to Trendelenburg position during laparoscopic surgery: recommendations and review of the literature. Curr Opin Obstet Gynecol 2018; 30:272-278. [DOI: 10.1097/gco.0000000000000471] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Abstract
Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.
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23
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Kim MS, Soh S, Kim SY, Song MS, Park JH. Comparisons of Pressure-controlled Ventilation with Volume Guarantee and Volume-controlled 1:1 Equal Ratio Ventilation on Oxygenation and Respiratory Mechanics during Robot-assisted Laparoscopic Radical Prostatectomy: a Randomized-controlled Trial. Int J Med Sci 2018; 15:1522-1529. [PMID: 30443174 PMCID: PMC6216054 DOI: 10.7150/ijms.28442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/06/2018] [Indexed: 01/13/2023] Open
Abstract
Background: During robot-assisted laparoscopic radical prostatectomy (RALP), steep Trendelenburg position and carbon dioxide pneumoperitoneum are inevitable for surgical exposure, both of which can impair cardiopulmonary function. This study was aimed to compare the effects of pressure-controlled ventilation with volume guarantee (PCV with VG) and 1:1 equal ratio ventilation (ERV) on oxygenation, respiratory mechanics and hemodynamics during RALP. Methods: Eighty patients scheduled for RALP were randomly allocated to either the PCV with VG or ERV group. After anesthesia induction, volume-controlled ventilation (VCV) was applied with an inspiratory to expiratory (I/E) ratio of 1:2. Immediately after pneumoperitoneum and Trendelenburg positioning, VCV with I/E ratio of 1:1 (ERV group) or PCV with VG using Autoflow mode (PCV with VG group) was initiated. At the end of Trendelenburg position, VCV with I/E ratio of 1:2 was resumed. Analysis of arterial blood gases, respiratory mechanics, and hemodynamics were compared between groups at four times: 10 min after anesthesia induction (T1), 30 and 60 min after pneumoperitoneum and Trendelenburg positioning (T2 and T3), and 10 min after desufflation and resuming the supine position (T4). Results: There were no significant differences in arterial blood gas analyses including arterial oxygen tension (PaO2) between groups throughout the study period. Mean airway pressure (Pmean) were significantly higher in the ERV group than in the PCV with VG group T2 (p<0.001) and T3 (p=0.002). Peak airway pressure and hemodynamic data were comparable in both groups. Conclusion: PCV with VG was an acceptable alternative to ERV during RALP producing similar PaO2 values. The lower Pmean with PCV with VG suggests that it may be preferable in patients with reduced cardiovascular function.
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Affiliation(s)
- Min-Soo Kim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sarah Soh
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - So Yeon Kim
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Sup Song
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ha Park
- Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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24
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Anesthesia for Robot Assisted Gynecological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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La Falce S, Novara G, Gandaglia G, Umari P, De Naeyer G, D'Hondt F, Beresian J, Carette R, Penicka M, Mo Y, Vandenbroucke G, Mottrie A. Low Pressure Robot-assisted Radical Prostatectomy With the AirSeal System at OLV Hospital: Results From a Prospective Study. Clin Genitourin Cancer 2017; 15:e1029-e1037. [DOI: 10.1016/j.clgc.2017.05.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/16/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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26
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Bedirli N, Emmez G, Ünal Y, Tönge M, Emmez H. Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine mode. Turk J Med Sci 2017; 47:1610-1615. [PMID: 29152942 DOI: 10.3906/sag-1609-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: This study was undertaken to evaluate the effects of positive end-expiratory pressure (PEEP) levels on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to determine the appropriate PEEP level during steep Trendelenburg position combined with pneumoperitoneum.Materials and methods: Ten pigs were included in this study. Pneumoperitoneum and Trendelenburg position were maintained and PEEP titration was initiated. Arterial pressure, heart rate, arterial blood gas, ICP, and CPP were recorded at the following time points: baseline (T0), 30 min after positioning and pneumoperitoneum (T1), PEEP 5 (T2), PEEP 10 (T3), PEEP 15 (T4), and PEEP 20 (T5).Results: MAP significantly increased at T1 compared to T0 and decreased at T4 and T5 compared to T1. ICP was 9.5 mmHg and CPP was 69.3 mmHg at T0. CO2 insufflation and steep Trendelenburg position did not cause any significant difference in ICP and CPP. ICP increased and CPP decreased significantly at T4 and T5 compared to both T0 and T1. PaO2 and PaO2/FiO2 decreased significantly at T1 and T2 compared to T0, while both increased significantly at T3, T4, and T5 compared to T1.Conclusion: PEEP of 10 cmH2O was effective for providing oxygenation while preserving hemodynamic stability, ICP, and CPP in this model.
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27
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Ono N, Nakahira J, Nakano S, Sawai T, Minami T. Changes in cardiac function and hemodynamics during robot-assisted laparoscopic prostatectomy with steep head-down tilt: a prospective observational study. BMC Res Notes 2017; 10:341. [PMID: 28754145 PMCID: PMC5534046 DOI: 10.1186/s13104-017-2672-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 07/22/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Robot-assisted laparoscopic prostatectomy requires the patient to be placed in a steep head-down tilt. The aim of our study was to investigate changes in cardiac index and left ventricular end-diastolic volume in a steep had-down tilt. This is a prospective observational study. We investigated the influence of steep head-down tilt on cardiac function and hemodynamics without fluid restriction in 12 men of American Society of Anesthesiologists physical status I-II undergoing robot-assisted laparoscopic prostatectomy. We measured left ventricular ejection fraction, left ventricular end-diastolic volume and cardiac index by transesophageal echocardiography, cardiac index using a FloTrac® sensor, heart rate and arterial blood pressure, before and 5 min after tilting the operating table. RESULTS The following variables changed significantly after tilting and establishment of the pneumoperitoneum: left ventricular ejection fraction (before 62.5%, after 55.5%; P = 0.040), systolic blood pressure (before 116 mmHg, after 128 mmHg; P = 0.001) and diastolic blood pressure (before 59 mmHg, after 70 mmHg; P = 0.002). There were no significant changes in cardiac index or left ventricular end-diastolic volume measured by transesophageal echocardiography, or cardiac index by FloTrac® sensor. Left ventricular ejection fraction decreased, whereas cardiac index and left ventricular end-diastolic volume did not change, indicating that steep head-down tilt and pneumoperitoneum during robot-assisted laparoscopic prostatectomy did not greatly influence cardiac function. This study was registered as a clinical study with the Japanese Official Clinical Trial Registry (Trial Registration Number JMA-IIA00158 on 7th January, 2014).
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Affiliation(s)
- Naomi Ono
- Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Junko Nakahira
- Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Shoko Nakano
- Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Toshiyuki Sawai
- Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Effects of Pneumoperitoneum and the Steep Trendelenburg Position on Heart Rate Variability and Cerebral Oxygenation during Robotic Sacrocolpopexy. J Minim Invasive Gynecol 2017; 25:70-75. [PMID: 28734974 DOI: 10.1016/j.jmig.2017.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 01/27/2023]
Abstract
STUDY OBJECTIVE The aim of this study was to investigate how steep Trendelenburg positioning with pneumoperitoneum modifies brain oxygenation and autonomic nervous system modulation of heart rate variability during robotic sacrocolpopexy. DESIGN Prospective study (Canadian Task Force classification III). SETTING Rambam Health Care Campus. PATIENTS Eighteen women who underwent robotic sacrocolpopexy for treatment of uterovaginal or vaginal apical prolapse. INTERVENTIONS Robotic sacrocolpopexy. MEASUREMENTS AND MAIN RESULTS A 5-minute computerized electrocardiogram, cerebral O2 saturation (cSO2), systemic O2 saturation, heart rate (HR), diastolic blood pressure (BP), systolic BP, and end-tidal CO2 tension were recorded immediately after anesthesia induction (baseline phase) and after alterations in positioning and in intra-abdominal pressure. HR variability was assessed in time and frequency domains. Cerebral oxygenation was measured by the technology of near-infrared spectrometry. cSO2 at baseline was 73% ± 9%, with minor and insignificant elevation during the operation. Mean HR decreased significantly when the steep Trendelenburg position was implemented (66 ± 10 vs 55 ± 9 bpm, p < .05) and returned gradually to baseline with advancement of the operation and the decrease in intra-abdominal pressure. Concomitant with this decrease, the power of both arms of the autonomic nervous system increased significantly (2.8 ± .8 vs 3.3 ± .9 ms2/Hz and 2.5 ± 1.2 vs 3.2 ± .9 ms2/Hz, respectively, p < .05). All these effects occurred without any significant shifts in systolic or diastolic BP or in systemic or cerebral oxygenation. CONCLUSION This study supports the safety of robotic sacrocolpopexy performed with steep Trendelenburg positioning with pneumoperitoneum. Only minor alterations were observed in cerebral oxygenation and autonomic perturbations, which did not cause clinically significant alterations in HR rate and HR variability.
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Zillioux JM, Krupski TL. Patient positioning during minimally invasive surgery: what is current best practice? ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:69-76. [PMID: 30697565 PMCID: PMC6193419 DOI: 10.2147/rsrr.s115239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction Positioning injuries are a known surgical complication and can result in significant patient morbidity. Studies have shown a small but significant number of neurovascular injuries associated with minimally invasive surgery, due to both patient and case-specific factors. We sought to review the available literature in regards to pathophysiological and practical recommendations. Methods A literature search was conducted and categorized by level of evidence, with emphasis on prospective studies. The result comprised 14 studies, which were summarized and analyzed with respect to our study objectives. Results While incidence of positioning injury has been identified in up to one-third of prospective populations, its true prevalence after surgery is likely 2%-5%. The mechanism is thought to be intraneural disruption from stretching or pressure, which results in decreased perfusion. On a larger scale, this vascular compromise can lead to ischemia and rhabdomyolysis. Prevention hinges on addressing patient modifiable factors such as body mass index, judicious positioning with appropriate devices, and intraoperative team awareness consisting of recurrent extremity checks and time management. Conclusion The risk for positioning injuries is underappreciated. Surgeons who perform minimally invasive surgery should discuss the potential for these complications with their patients, and operative teams should take steps to minimize risk factors.
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Affiliation(s)
| | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA, USA,
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Dabrowski W, Jaroszynski A, Jaroszynska A, Rzecki Z, Schlegel TT, Malbrain MLNG. Intra-abdominal hypertension increases spatial QRS-T angle and elevates ST-segment J-point in healthy women undergoing laparoscopic surgery. J Electrocardiol 2017; 50:214-222. [PMID: 28029353 DOI: 10.1016/j.jelectrocard.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Indexed: 10/20/2022]
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Bozkirli F, Bedirli N, Akçabay M. Effects of steep Trendelenburg position and pneumoperitoneum on middleear pressure in patients undergoing robotic radical prostatectomy. Turk J Med Sci 2017; 47:295-299. [PMID: 28263505 DOI: 10.3906/sag-1601-113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/26/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of this study was to quantify the changes in middle ear pressure (MEP) during robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS Thirty patients undergoing RARP were included in this study. MEP was obtained at the following time points: awake (T1), postintubation (T2), pneumoperitoneum + 1 h of Trendelenburg position (T3), pneumoperitoneum + 2 h of Trendelenburg position (T4), pneumoperitoneum + 3 h of Trendelenburg position (T5), desufflation + supine position (T6), and 1 h after extubation in the postanesthesia care unit (T7). Heart rate, mean arterial pressure (MAP), peak airway pressure (PAP), tidal volume, minute ventilation, EtCO2, and blood gas values were recorded. RESULTS MEP was significantly higher at T4, T5, T6, and T7 as compared to T1 values. PAP values were significantly increased at T3, T4, and T5 compared to T2. MAP values at T3, T4, and T5 were significantly higher compared to T1. PaCO2 increased significantly at T4, T5, and T6 and pH decreased significantly at T4 and T5 when compared to T2. CONCLUSION The combination of steep Trendelenburg position and pneumoperitoneum during RARP caused a significant increase in MEP, PaCO2, and EtCO2 levels. This propensity for increased MEP may cause problems in patients with preexisting ear disease.
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Affiliation(s)
- Fusun Bozkirli
- Department of Anesthesiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Nurdan Bedirli
- Department of Anesthesiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mehmet Akçabay
- Department of Anesthesiology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Comparison of the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery in the Trendelenburg position: study protocol for a randomized controlled trial. Trials 2016; 17:488. [PMID: 27724965 PMCID: PMC5057242 DOI: 10.1186/s13063-016-1609-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 09/17/2016] [Indexed: 11/10/2022] Open
Abstract
Background Robot-assisted laparoscopic radical prostatectomy and robot-assisted radical cystectomy have gradually become the preferred choices for urologists as they allow surgeons to perform complex procedures more precisely and effectively. The pneumoperitoneum, which is normally applied in these surgeries to provide visual clarity and space to perform the procedure, may cause hemodynamic disturbance, potentially myocardial injury. Thus surgeons have recently considered opting for the low-pressure pneumoperitoneum to lower this negative impact. Herein we describe a protocol for a clinical trial to compare the impact of prolonged low-pressure and standard-pressure pneumoperitoneum on myocardial injury after robot-assisted surgery. Methods/design This study is designed to be a bicenter clinical trial. In total 280 patients scheduled to undergo robot-assisted laparoscopic radical prostatectomy or robot-assisted radical cystectomy will be enrolled and randomized into two groups, with standard- (12–16 mmHg) and low-pressure (7–10 mmHg) pneumoperitoneum, respectively. Troponin T will be measured as the primary endpoint to assess the extent of myocardial injury. Nt-proBNP and hemodynamic indexes will also be recorded for further analysis. Discussion The significance of this study is emphasized by the fact that there are few studies that have focused on the impact of prolonged pneumoperitoneum on myocardial injury, which is relevant to postoperative mortality. We hope that the conclusions drawn from this study could provide reference and basis to the future of the pneumoperitoneum in clinical practice. Trial registration Registered at https://www.clinicaltrials.gov with the Identifier NCT02600481 on November 5, 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1609-5) contains supplementary material, which is available to authorized users.
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Bhama AR, Cleary RK. Setup and positioning in robotic colorectal surgery. SEMINARS IN COLON AND RECTAL SURGERY 2016. [DOI: 10.1053/j.scrs.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Zhu YF, Meng FM. Effect of Retroperitoneal Lavage with Normal Saline Containing Adrenaline on Carbon Dioxide Absorption in Patients Undergoing Retroperitoneal Laparoscopic Surgery. J Laparoendosc Adv Surg Tech A 2016; 25:903-7. [PMID: 26575248 DOI: 10.1089/lap.2015.0215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To determine the effect of lavage with adrenaline solution on CO2 absorption during retroperitoneal laparoscopic surgery. MATERIALS AND METHODS Sixty patients scheduled to undergo retroperitoneal laparoscopic surgery were divided into an AD group (lavage with normal saline containing adrenaline [1:500,000], n = 30) and an NS group (lavage with normal saline only, n = 30). After the establishment of artificial pneumoperitoneum and before the start of the operation, the retroperitoneal space was irrigated with 300 mL of normal saline with or without adrenaline, depending on the group. The lavage fluid was aspirated after 3 minutes. Heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), partial pressure of O2 (PaO2), partial pressure of CO2 (PaCO2), and end-tidal CO2 partial pressure (PETCO2) were recorded before the lavage (T0) and at 10, 30, 60, 90, and 120 minutes (T1-T5, respectively) after the lavage. The CO2 output (VCO2) was calculated, and the incidence of intraoperative arrhythmia and postoperative complications (e.g., headache, palpitations, irritation) was determined. RESULTS HR, MAP, SpO2, PaO2, PaCO2, PETCO2, and VCO2 at T0 did not significantly differ between the groups (P > .05). HR, PaCO2, PETCO2, and VCO2 at T1-T5 were lower in the AD group than in the NS group (P < .05). The incidence of intraoperative arrhythmia and postoperative complications was lower in the AD group than in the NS group (P < .05). CONCLUSIONS Lavage with normal saline containing adrenaline (1:500,000) reduced CO2 absorption during retroperitoneal laparoscopic surgery, prevented hypercapnia, and decreased intra- and postoperative complications.
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Affiliation(s)
- Yong-Feng Zhu
- Department of Anesthesiology, People's Hospital of Zhengzhou University , Zhengzhou, People's Republic of China
| | - Fan-Min Meng
- Department of Anesthesiology, People's Hospital of Zhengzhou University , Zhengzhou, People's Republic of China
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Kim NY, Han DW, Koh JC, Rha KH, Hong JH, Park JM, Kim SY. Effect of Dexmedetomidine on Heart Rate-Corrected QT and Tpeak-Tend Intervals During Robot-Assisted Laparoscopic Prostatectomy With Steep Trendelenburg Position: A Prospective, Randomized, Double-Blinded, Controlled Study. Medicine (Baltimore) 2016; 95:e3645. [PMID: 27175685 PMCID: PMC4902527 DOI: 10.1097/md.0000000000003645] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intraperitoneal insufflation of carbon dioxide may affect the sympathetic activity that leads to changes in ventricular repolarization. This in turn can result in changes of heart rate-corrected QT (QTc) interval and Tpeak-Tend (Tp-e) interval. Dexmedetomidine is a highly selective α2-receptor agonist and has potential antiarrhythmic properties. This prospective, randomized, double-blinded, controlled study evaluated the effects of dexmedetomidine administration on QTc and Tp-e intervals during robot-assisted laparoscopic prostatectomy with steep Trendelenburg position.Fifty patients scheduled for robot-assisted laparoscopic prostatectomy randomly received either a continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour, from anesthetic induction until the end of the Trendelenburg position (dexmedetomidine group; n = 25), or the same volume of normal saline (control group; n = 25). Anesthesia was maintained with sevoflurane and remifentanil. The primary and secondary goals were to evaluate the effect of dexmedetomidine on the QTc and Tp-e interval changes. Mean arterial pressure, heart rate, end-tidal CO2, and end-tidal sevoflurane concentrations were assessed as well.Forty-seven patients (94%) completed the study. Dexmedetomidine significantly attenuated QTc interval prolongation and reduced the Tp-e interval, even though the baseline values of the QTc and Tp-e intervals were similar between the 2 groups (PGroup × Time = 0.001 and 0.014, respectively). Twenty-two patients (96%) in the control group and 13 (54%) in the dexmedetomidine group had QTc interval prolongation of >20 ms from the baseline value during surgery (P = 0.001). The maximum QTc interval prolongation from the baseline value during surgery was 46 ± 21 ms in the control group and 24 ± 21 ms in the dexmedetomidine group (mean ± SD, P = 0.001). Mean arterial pressure and heart rate were comparable between the groups.Continuous infusion of dexmedetomidine at a rate of 0.3 μg/kg/hour significantly attenuated the QTc interval prolongation induced by CO2 pneumoperitoneum with steep Trendelenburg position. Furthermore, dexmedetomidine reduced the Tp-e interval. Thus, dexmedetomidine administration may be effective for patients who are susceptible to the development of ventricular arrhythmia during robot-assisted laparoscopic prostatectomy.
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Affiliation(s)
- Na Young Kim
- From the Department of Anesthesiology and Pain Medicine (NYK, DWH, JCK, JMP, SYK); Anesthesia and Pain Research Institute (NYK, DWH, JCK, SYK); Department of Urology, Urological Science Institute (KHR); Department of Research Affairs, Biostatistics Collaboration Units (JHH), Yonsei University College of Medicine, Seoul, Republic of Korea
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Couwenberg AM, Burbach MJP, Smits AB, Van Vulpen M, Van Grevenstein WMU, Noordzij PG, Verkooijen HM. The impact of retractor SPONGE-assisted laparoscopic surgery on duration of hospital stay and postoperative complications in patients with colorectal cancer (SPONGE trial): study protocol for a randomized controlled trial. Trials 2016; 17:132. [PMID: 26964861 PMCID: PMC4787008 DOI: 10.1186/s13063-016-1256-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 02/24/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To achieve an adequate visual working field during laparoscopic colorectal surgery without disturbance of the small intestine, patients are positioned in the Trendelenburg position. This position results in hemodynamic changes that may increase the risk of cardiopulmonary complications and prolonged hospital stay. Recently, an intraoperative retractor sponge was introduced as an alternative to the Trendelenburg position during laparoscopic surgery. The objective of this trial is to study the impact of the use of an intraoperative retractor sponge on the duration of the hospital stay and risk of perioperative complications in patients undergoing laparoscopic surgery for colorectal cancer. METHODS/DESIGN The SPONGE trial is a monocenter study and follows the cohort multiple randomized controlled trial (cmRCT) design. It will be conducted within a multicenter prospective observational cohort of colorectal cancer patients of all stages, for whom longitudinal clinical data and patient-reported outcomes are collected. Patients within the cohort, who will undergo laparoscopic surgery for distal colon or rectal cancer, are eligible for inclusion and form a subcohort. From this subcohort, a 1:1 random sample will be offered to undergo surgery with the use of the retractor sponge. Patients from the subcohort who are not selected will undergo standard treatment, that is, surgery in the Trendelenburg position. The primary endpoint is the duration of the postoperative hospital stay. Secondary outcomes are duration of surgery; intraoperative blood loss and fluid balance; and postoperative body temperature, oxygenation and complications. Both arms require 94 patients. DISCUSSION This study is the first randomized controlled trial to evaluate the effect of sponge-assisted laparoscopic colorectal surgery in comparison with standard Trendelenburg position on hospital stay and peri- and postoperative complications. Results of this study will also be relevant for other surgical procedures in the pelvic region. The present study is the second randomized controlled trial according to the cmRCT design, which is embedded within our colorectal cancer cohort. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02574013 . Registered 27 September 2015.
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Affiliation(s)
- Alice M Couwenberg
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands.
| | - Maarten J P Burbach
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | - Anke B Smits
- Department of Surgery, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
| | - Marco Van Vulpen
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
| | | | - Peter G Noordzij
- Department of Anesthesiology, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3430 EM, The Netherlands
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3508 GA, The Netherlands
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Obesity is associated with decreased lung compliance and hypercapnia during robotic assisted surgery. J Clin Monit Comput 2016; 31:85-92. [PMID: 26823286 PMCID: PMC5253149 DOI: 10.1007/s10877-016-9831-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 01/19/2016] [Indexed: 12/03/2022]
Abstract
Robotic assisted surgery (RAS) represents a great challenge for anesthesiology due to the increased intraabdomial pressures required for surgical optimal approach. The changes in lung physiology are difficult to predict and require fast decision making in order to prevent altered gas exchange. The aim of this study was to document the combined effect of patient physical status, medical history and intraoperative position during RAS on lung physiology and to determine perioperative risk factors for hypercapnia. We prospectively analyzed 62 patients who underwent elective RAS. Age, co-morbidities and body mass index (BMI) were recorded before surgery. Ventilatory parameters and arterial blood gas analysis were determined before induction of anesthesia, after tracheal intubation and on an hourly basis until the end of surgery. In RAS, the induction of pneumoperitoneum was associated with a significant decrease in lung compliance from a mean of 42.5–26.7 ml cm H2O−1 (p = 0.001) and an increase in plateau pressure from a mean of 16.1 mmHg to a mean of 23.6 mmHg (p = 0.001). Obesity, demonstrated by a BMI over 30, significantly correlates with a decrease in lung compliance after induction of anesthesia (p = 0.001). A significant higher increase in arterial CO2 tension was registered in patients undergoing RAS in steep Trendelenburg position (p = 0.05), but no significant changes in end-tidal CO2 were recorded. A higher arterial to end-tidal CO2 tension gradient was observed in patients with a BMI > 30 (p < 0.001). In conclusion, patients’ physical status, especially obesity, represents the main risk factor for decreased lung compliance during RAS and patient positioning in either Trendelenburg or steep Trendelenburg during surgery has limited effects on respiratory physiology.
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Samhan Y, Radwan K, Youssef M, Ebied R, Zeidan M, El Bendary O, Hassan M. Hemodynamic changes and stress response during BIS-guided TCI anesthesia with propofol-fentanyl in laparoscopic versus open cholecystectomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2016. [DOI: 10.1016/j.egja.2015.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Yasser Samhan
- Department of Anesthesia, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
| | - Khalda Radwan
- Department of Anesthesia, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
| | - Maha Youssef
- Department of Anesthesia, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
| | - Reham Ebied
- Department of Anesthesia, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
| | - Mohamed Zeidan
- Department of Anesthesia, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
| | - Omnia El Bendary
- Department of Clinical Chemistry, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
| | - Mona Hassan
- Department of Clinical Chemistry, Theodor Bilharz Research Institute, Ministry of Scientific Research, P.O. Box 30, Warak El-Hadar, Kornish El-Nile, Imbaba, Giza, 12411, Egypt
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Beauval JB, Mazerolles M, Salomon L, Soulié M. Évaluation préthérapeutique du patient candidat à la chirurgie du cancer de la prostate. Prog Urol 2015; 25:947-65. [DOI: 10.1016/j.purol.2015.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 10/22/2022]
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Seo H, Kong YG, Jin SJ, Chin JH, Kim HY, Lee YK, Hwang JH, Kim YK. Dynamic Arterial Elastance in Predicting Arterial Pressure Increase After Fluid Challenge During Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study. Medicine (Baltimore) 2015; 94:e1794. [PMID: 26469925 PMCID: PMC4616778 DOI: 10.1097/md.0000000000001794] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
During robot-assisted laparoscopic prostatectomy, specific physiological conditions such as carbon dioxide insufflation and the steep Trendelenburg position can alter the cardiac workload and cerebral hemodynamics. Inadequate arterial blood pressure is associated with hypoperfusion, organ damage, and poor outcomes. Dynamic arterial elastance (Ea) has been proposed to be a useful index of fluid management in hypotensive patients. We therefore evaluated whether dynamic Ea can predict a mean arterial pressure (MAP) increase ≥ 15% after fluid challenge during pneumoperitoneum and the steep Trendelenburg position.We enrolled 39 patients receiving robot-assisted laparoscopic prostatectomy. Fluid challenge was performed with 500 mL colloids in the presence of preload-dependent conditions and arterial hypotension. Patients were classified as arterial pressure responders or arterial pressure nonresponders according to whether they showed an MAP increase ≥15% after fluid challenge. Dynamic Ea was defined as the ratio between the pulse pressure variation and stroke volume variation. Receiver operating characteristic curve analysis was performed to assess the arterial pressure responsiveness after fluid challenge during robot-assisted laparoscopic prostatectomy.Of the 39 patients, 17 were arterial pressure responders and 22 were arterial pressure nonresponders. The mean dynamic Ea before fluid challenge was significantly higher in arterial pressure responders than in arterial pressure nonresponders (0.79 vs 0.61, P < 0.001). In receiver operating characteristic curve analysis, dynamic Ea showed an area under the curve of 0.810. The optimal cut-off value of dynamic Ea for predicting an MAP increase of ≥ 15% after fluid challenge was 0.74.Dynamic Ea can predict an MAP increase ≥ 15% after fluid challenge during robot-assisted laparoscopic prostatectomy. This result suggests that evaluation of arterial pressure responsiveness using dynamic Ea helps to maintain an adequate arterial blood pressure and to improve perioperative outcomes in preload-dependent patients receiving robot-assisted laparoscopic prostatectomy under pneumoperitoneum and in the steep Trendelenburg position.
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Affiliation(s)
- Hyungseok Seo
- From the Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea (HS); Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (Y-GK, S-JJ, J-HC, J-HH, Y-KK); and Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea (H-YK, Y-KL)
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España Fuente L, Fernández Diez A, Pérez Villafañe A. [Otorrhagia. A complication of laparoscopic hemicolectomy]. ACTA ACUST UNITED AC 2015; 63:112-5. [PMID: 26141570 DOI: 10.1016/j.redar.2015.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/04/2015] [Accepted: 04/08/2015] [Indexed: 11/19/2022]
Abstract
The fast and increasing advance in surgical technology during the last decades has led to a remarkable development in laparoscopic surgery. "Minimally invasive" surgery has become very popular in the last few years, not only in gynecological procedures but also in general surgery, orthopedics, thoracic and urological procedures. Gas inflation into the abdominal cavity and patient position provokes physiological changes, as well as complications that are not seen in open surgery. Pneumoperitoneum and the Trendelenburg position beyond 35° cause hemodynamic changes, resulting in an increase in arterial and central venous pressure. The external auditory canal vessels are directly affected by these changes, and postoperative otorrhagia after a prolonged laparoscopic surgery may be present. A case is presented of postoperative bilateral otorrhagia after laparoscopic left hemicolectomy.
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Affiliation(s)
- L España Fuente
- Servicio de Anestesiología y Reanimación, Hospital San Agustín, Avilés, Asturias, España.
| | - A Fernández Diez
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario de León, León, España
| | - A Pérez Villafañe
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario de León, León, España
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42
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Kazakov AS, Kolontarev KB, Pushkar' DI, Pasechnik IN. [Anesthetic management of robot-assisted radical prostatectomy]. Khirurgiia (Mosk) 2015:56-62. [PMID: 26031821 DOI: 10.17116/hirurgia2015256-62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The authors have an experience in performing of 700 radical prostatectomies by using of daVinci-robot. The main factors determining parameters of operation and anesthesia are presented in the article. The authors give recommendations for optimization of anesthetic management. The main features of patient preparation for robot-assisted radical prostatectomy, parameters of anesthesia and postoperative management of patients are presented in the article.
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Affiliation(s)
| | - K B Kolontarev
- Moskovskiĭ gosudarstvennyĭ meditsinskiĭ stomatologicheskiĭ universitet im. A.I. Evdokimova
| | - D Iu Pushkar'
- Moskovskiĭ gosudarstvennyĭ meditsinskiĭ stomatologicheskiĭ universitet im. A.I. Evdokimova
| | - I N Pasechnik
- Uchebno-nauchnyĭ meditsinskiĭ tsentr Upravleniia delami Prezidenta RF, Moskva
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Agrawal M, Dureja V, Verma AP, Kang LS. A comparative study of four combinations of anesthetic drugs for assessing the intraocular pressure changes during gynaecological laparoscopic procedures. Anesth Essays Res 2015; 7:319-25. [PMID: 25885976 PMCID: PMC4173539 DOI: 10.4103/0259-1162.123221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims and Objectives: Laparoscopic surgery is the choice for gynaecological surgery these days, but pneumoperitoneum (PNO) and trendelenburg position increase the intraocular pressure (IOP) leading to decrease in perfusion of retina and at times the significant risk of ischemic retinopathy. Our present aim is to find out the suitable combination of induction and maintenance agent for combating the increase in IOP by PNO, lithotomy and trendelenburg position, and to study the changes in IOP at different time points and positions in gynaecological laparoscopic procedures. Patients and methods: After taking permission from the Ethical Committee 120 female patients of ASA grade 1 and II were divided arbitrarily in four groups each comprising 30 patients. In group A and B induction was done with propofol 2.5 mg/kg given IV and in group C and D induction was done with thiopentone 5 mg/kg given IV. Atracurium 0.5 mg/kg IV was used as neuromuscular blocking agent (NMBA).Laryngeal mask airway (LMA) was inserted in all the cases and patients were ventilated with Bain's circuit. Maintenance of anesthesia was done with total intra venous anesthesia (TIVA) with propofol and100% oxygen in group A and C. In group B and D maintenance was done with 1% isoflurane with oxygen (O2) and nitrous oxide (N2O) in the ratio of 40:60. Changes in IOP, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) were measured. Baseline readings were taken initially and then 2 min after premedication, 1 min after LMA insertion, 1 min after PNO with lithotomy position, 5 min after 20° head down tilt and PNO in situ and 2 min after exsufflation of PNO with supine horizontal position. Results and Conclusion: To mitigate increase in IOP during gynaecological laparoscopic surgeries, propofol, and propofol TIVA (Group A) proved to be the best option. Propofol and isoflurane (Group B) thiopentone and propofol TIVA (Group C) were not as effective as group A. However, induction with thiopentone and maintenance with isoflurane (Group D) were not effective at all.
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Affiliation(s)
- Malti Agrawal
- Department of Anaesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Vijay Dureja
- Department of Anaesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Ananda Prakash Verma
- Department of Anaesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
| | - Lakhwinder Singh Kang
- Department of Anaesthesiology and Critical Care, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India
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Özdemir M, Yanlı PY, Tomruk ŞG, Bakan N. Anaesthesia Management of a Patient with Incidentally Diagnosed Diaphragmatic Hernia During Laparoscopic Surgery. Turk J Anaesthesiol Reanim 2015; 43:50-4. [PMID: 27366465 DOI: 10.5152/tjar.2014.82787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 04/01/2014] [Indexed: 11/22/2022] Open
Abstract
Diaphragmatic hernia is usually congenital. However, it is rarely traumatic and can stay asymptomatic. In this report, we aimed to present the anaesthetic management of a patient with diaphragmatic hernia due to previous trauma (14 years ago), which was diagnosed incidentally during surgery for rectal cancer. The patient (53 years, 56 kg, 165 cm, American Society of Anaesthesiologist (ASA) II), to whom laparoscopic surgery was planned because of rectal cancer, had a history of falling from a height 14 years ago. Preoperatively, the patient did not have any sign except small right diaphragmatic elevation on the chest x-ray. After induction, maintenance of anaesthesia was continued with sevoflurane and O2/N2O. The patient was given a 30° Trendelenburg position. When the trochars were inserted by the surgeon, the diaphragmatic hernia was seen on the right part of the diaphragm, which was hidden by the liver. The surgery was continued laparoscopically but with low pressure (12 mmHg), because the patient did not have any haemodynamic and respiratory instability. The patient, who had stable haemodynamic parameters and no respiratory complications during the operation, was transferred to the ward for monitorised care. Traumatic diaphragmatic hernias can be detected incidentally after a long period of acute event. In our case, it was diagnosed during laparoscopic surgery. The surgery was completed with appropriate and careful haemodynamic monitoring and low intra-abdominal pressure under inhalational anaesthesia without any impairment in the patient's haemodynamic and respiratory parameters.
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Affiliation(s)
- Mehtap Özdemir
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Pınar Yonca Yanlı
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Şenay Göksu Tomruk
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Nurten Bakan
- Clinic of Anaesthesiology and Reanimation, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Kilic O, Börgers A, Köhne W, Musch M, Kröpfl D, Groeben H. Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra- and extrathoracic airways in patients with or without chronic obstructive pulmonary disease. Br J Anaesth 2015; 114:70-6. [DOI: 10.1093/bja/aeu322] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Intraoperative Ear Bleeding With Bilateral Otorrhagia During Laparoscopic Sacrocolpopexy. Female Pelvic Med Reconstr Surg 2015; 21:e6-7. [DOI: 10.1097/spv.0000000000000088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kumagai M, Ogawa S, Doe A, Suzuki K. Cerebral oxygenation measured by near-infrared spectroscopy and jugular vein oxygen saturation during robotic-assisted laparoscopic radical prostatectomy under total intravenous anaesthesia. Int J Med Robot 2014; 11:302-307. [PMID: 25331731 DOI: 10.1002/rcs.1629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND The effects of total intravenous anaesthesia (TIVA) on cerebral oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) have not been investigated. We examined the changes in jugular venous oxygen saturation (SjvO2 ) and regional cerebral tissue oxygen saturation (rSO2 ) during RALP under TIVA. Whether rSO2 could reflect SjvO2 was also examined. METHODS Forty patients (ASA 1-2) undergoing RALP were enrolled. Measurements were obtained at eight time points during the operation. RESULTS SjvO2 did not decrease at any measurement point, whereas rSO2 fell significantly 120 min after pneumoperitoneum in a steep Trendelenburg position (p <0.01). There was a weak correlation between SjvO2 and rSO2 (Pearson correlation coefficient =0.34; p <0.01). Bland-Altman analysis showed a wide interval for the limit of agreement (47%) between the two measurements. CONCLUSIONS These findings suggested that TIVA could be safely used for RALP. It was also demonstrated that rSO2 did not accurately reflect SjvO2 during RALP. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Motoi Kumagai
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Shohei Ogawa
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Aya Doe
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
| | - Kenji Suzuki
- Department of Anaesthesiology, School of Medicine, Iwate Medical University, Morioka, Japan
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Closhen D, Treiber AH, Berres M, Sebastiani A, Werner C, Engelhard K, Schramm P. Robotic assisted prostatic surgery in the Trendelenburg position does not impair cerebral oxygenation measured using two different monitors: A clinical observational study. Eur J Anaesthesiol 2014; 31:104-9. [PMID: 24225725 DOI: 10.1097/eja.0000000000000000] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Robotic assisted prostatic surgery is frequently used because of its reduced side-effects compared with conventional surgery. During surgery, an extreme Trendelenburg position and CO2 pneumoperitoneum are necessary, which may lead to cerebral oedema, can potentially reduce brain perfusion and therefore could impair cerebral oxygenation. Cerebral oxygen saturation can be measured non-invasively using near-infrared spectroscopy (NIRS). OBJECTIVE The hypothesis of the present study was that steep Trendelenburg positioning during robotic assisted prostatic surgery impairs cerebral oxygen saturation measured using two different NIRS monitors. DESIGN Clinical observational study. SETTING Primary care university hospital, study period from March 2012 to February 2013. PATIENTS A total of 29 patients scheduled for robotic assisted prostatic surgery in a steep Trendelenburg position. INTERVENTIONS Cerebral oxygen saturation was measured throughout anaesthesia using the INVOS sensor (a trend monitor using two infrared wavelengths) for one hemisphere and the FORE-SIGHT sensor (a monitor using four wavelengths of laser light to calculate absolute oxygen saturation) for the other hemisphere in an alternate randomisation. MAIN OUTCOME MEASURE Changes in cerebral oxygenation of more than 5% during surgery in the Trendelenburg position. RESULTS The median duration of Trendelenburg positioning was 190 (interquartile range 130 to 230) min. Cerebral oxygen saturation decreased with INVOS from 74 ± 5% at baseline to a lowest value of 70 ± 4% with a slope of -0.0129 min(-1) (P < 0.01) and with FORE-SIGHT from 72 ± 5% at baseline to a nadir of 70 ± 3% with a slope of -0.008 min(-1) (P < 0.01). Comparing INVOS with FORE-SIGHT, there was a good association, with a slope of 0.86 ± 0.04 (P < 0.01). CONCLUSION Both monitors showed a clinically irrelevant decrease in cerebral oxygen saturation of less than 5% over 4 h in a steep Trendelenburg position combined with CO2 pneumoperitoneum in patients undergoing robotic assisted prostatic surgery. This extreme positioning seems to be acceptable with regard to cerebral oxygenation. TRIAL REGISTRATION clinicaltrials.gov Identifier: ID NCT01275898.
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Affiliation(s)
- Dorothea Closhen
- From the Department of Anaesthesiology (DC, A-HT, AS, CW, KE, PS); Institute of Medical Biometry, Epidemiology and Informatics (IMBEI), University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz (MB); Department of Mathematics and Technology, RheinAhrCampus, Remagen, Germany (MB)
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Rosendal C, Markin S, Hien MD, Motsch J, Roggenbach J. Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy. J Clin Anesth 2014; 26:383-9. [PMID: 25086483 DOI: 10.1016/j.jclinane.2014.01.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 01/01/2014] [Accepted: 01/19/2014] [Indexed: 11/24/2022]
Abstract
STUDY OBJECTIVE To determine and interpret the changes in preload, afterload, and cardiac function in the different phases of robot-assisted laparoscopic prostatectomy. DESIGN Prospective, observational monocenter study. SETTING Operating room at a university hospital. PATIENTS 31 consecutive, ASA physical status 1, 2, and 3 patients. INTERVENTIONS Observations were made at 5 distinct time points: baseline after induction of anesthesia, after initiation of capnoperitoneum, immediately after a 45° head-down tilt, 15 minutes after the 45° head-down tilt was established, after the release of the capnoperitoneum, and 5 minutes after the patient was returned to a horizontal position (end). MEASUREMENTS Transpulmonary thermodilution and pulse contour analysis were used to record hemodynamic changes in preload, afterload, and cardiac function. MAIN RESULTS While central venous pressure increased threefold from baseline, none of the other preload parameters showed excessive fluid overload or demand. There was no significant change in cardiac contractility over time. Afterload increased significantly during the capnoperitoneum and significantly decreased compared with baseline after the release of abdominal pressure at the end of the procedure. Heart rate and cardiac index increased significantly during robot-assisted laparoscopic prostatectomy. CONCLUSIONS Selective arterial vasodilation at the time of capnoperitoneum may normalize afterload and myocardial oxygen demand.
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Affiliation(s)
- Christian Rosendal
- Hirslanden Clinics Berne, Klinik Beau-Site, Schänzlihalde 11, 3000 Bern 25, Switzerland; Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany.
| | - Sergei Markin
- Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - Maximilian D Hien
- Research Training Group 1126, University of Heidelberg, German Research Foundation (DFG), INF 110, 69120 Heidelberg, Germany; Department of Pediatrics, University of Heidelberg, INF 430, 69120 Heidelberg, Germany
| | - Johann Motsch
- Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
| | - Jens Roggenbach
- Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany
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Domi R, Sula H, Ohri I, Beqiri A, Kaci M, Bodeci A, Laho H. Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery. Int Arch Med 2014; 7:17. [PMID: 24791166 PMCID: PMC4005855 DOI: 10.1186/1755-7682-7-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 04/20/2014] [Indexed: 11/23/2022] Open
Abstract
The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia's safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist.
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Affiliation(s)
- Rudin Domi
- Department of Anesthesiology and Intensive Care, “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Hektor Sula
- Department of Anesthesiology and Intensive Care, “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Ilir Ohri
- Department of Anesthesiology and Intensive Care, “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Arben Beqiri
- Department of General Surgery, “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Myzafer Kaci
- Department of General Surgery, “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Artan Bodeci
- Department of General Surgery, “Mother Teresa” University Hospital Center, Tirana, Albania
| | - Haki Laho
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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