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The effect of moderate intraoperative blood loss and norepinephrine therapy on sublingual microcirculatory perfusion in patients having open radical prostatectomy: An observational study. Eur J Anaesthesiol 2021; 38:459-467. [PMID: 33443379 DOI: 10.1097/eja.0000000000001434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is not clear whether moderate intraoperative blood loss and norepinephrine used to restore the macrocirculation impair the microcirculation and affect microcirculation/macrocirculation coherence. OBJECTIVE We sought to investigate the effect of moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension on the sublingual microcirculation. DESIGN Prospective observational study. SETTING University Medical Center Hamburg-Eppendorf, Hamburg, Germany, from November 2018 to March 2019. PATIENTS Thirty patients scheduled for open radical prostatectomy and 29 healthy volunteer blood donors. INTERVENTION Simultaneous assessment of the macrocirculation using a noninvasive finger-cuff method and the sublingual microcirculation using vital microscopy. MAIN OUTCOME MEASURES The main outcome measures were changes in the sublingual microcirculation caused by moderate intraoperative blood loss and norepinephrine therapy. RESULTS General anaesthesia decreased median [IQR] mean arterial pressure from 100 [90 to 104] to 79 [69 to 87] mmHg (P < 0.001), median heart rate from 69 [63 to 79] to 53 [44 to 62] beats per minute (P < 0.001), median cardiac index from 2.67 [2.42 to 3.17] to 2.09 [1.74 to 2.49] l min-1 m-2 (P < 0.001), and median microvascular flow index from 2.75 [2.66 to 2.85] to 2.50 [2.35 to 2.63] (P = 0.001). A median blood loss of 600 [438 to 913] ml until the time of prostate removal and norepinephrine therapy to treat intraoperative hypotension had no detrimental effect on the sublingual microcirculation: There were no clinically important changes in the microvascular flow index, the proportion of perfused vessels, the total vessel density, and the perfused vessel density. Blood donation resulted in no clinically important changes in any of the macrocirculatory or microcirculatory variables. CONCLUSION Moderate intraoperative blood loss and norepinephrine therapy administered to treat intraoperative hypotension have no detrimental effect on the sublingual microcirculation and the coherence between the macrocirculation and microcirculation in patients having open radical prostatectomy.
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Abstract
Radical prostatectomy (RP) is a common treatment choice for localized prostate cancer. While there is increasing utilisation of robotic assisted RP in some centres, open RP (ORP) remains well established and commonly performed in many parts of the world. The goals of modern ORP are to remove the prostate en-bloc with negative surgical margins, while minimising blood loss and preserving urinary continence and erectile function. We present a technical review of ORP incorporating contemporary techniques for control of the deep venous complex, additional haemostatic measures, nerve-sparing and vesicourethral reconstruction.
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Affiliation(s)
- Ryan Pereira
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Andre Joshi
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Queensland University of Technology, Australian Prostate Cancer Research Centre, Brisbane, Queensland, Australia
| | - Matthew Roberts
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Nepean Urology Research Group, Kingswood, Australia
| | - John Yaxley
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, Brisbane, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Queensland University of Technology, Australian Prostate Cancer Research Centre, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
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Liu XJ, Liu L, Chang K, Ye DW, Zheng YF, Yao XD. Risk factors of perioperative complications in patients undergoing radical retropubic prostatectomy: A ten-year experience. ACTA ACUST UNITED AC 2017; 37:379-383. [PMID: 28585137 DOI: 10.1007/s11596-017-1743-7] [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: 12/20/2016] [Revised: 05/02/2017] [Indexed: 11/27/2022]
Abstract
Radical retropubic prostatectomy (RRP) has been one of the most effective treatments for prostate cancer. This study is designed to identify the related predictive risk factors for complications in patients following RRP. Between 2000 and 2012 in Department of Urology, Fudan University Shanghai Cancer Center, 421 cases undergoing RRP for localized prostate cancer by one surgeon were included in this retrospective analysis. We reviewed various risk factors that were correlated with perioperative complications, including patient characteristics [age, body mass index (BMI), co-morbidities], clinical findings (preoperative PSA level, Gleason score, clinical stage, pathological grade), and surgeon's own clinical practice. Charlson comorbidity index (CCI) was used to explain comorbidities. The total rate of perioperative complications was 23.2% (98/421). There were 45/421 (10.7%), 28/421 (6.6%), 24/421 (5.7%) and 1/421 (0.2%) in grade I, II, III, IV respectively, and 323/421 (76.8%) cases had none of these complications. Statistical analysis of multiple potential risk factors revealed that BMI >30 (P=0.014), Charlson score ≥1 (P<0.001) and surgical experience (P=0.0252) were predictors of perioperative complications. Age, PSA level, Gleason score, TNM stage, operation time, blood loss, and blood transfusion were not correlated with perioperative complications (P>0.05). It was concluded that patients' own factors and surgeons' technical factors are related with an increased risk of development of perioperative complications following radical prostatectomy. Knowing these predictors can both favor risk stratification of patients undergoing RRP and help surgeons make treatment decisions.
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Affiliation(s)
- Xiao-Jun Liu
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Liang Liu
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Kun Chang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yong-Fa Zheng
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Xu-Dong Yao
- Department of Urology, The Tenth People's Hospital Affiliated to Tongji University, Tongji University, Shanghai, 200032, China.
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Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer: a comparison with clinically localized prostate cancer. Asian J Androl 2012; 15:241-5. [PMID: 23223030 DOI: 10.1038/aja.2012.120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Radical prostatectomy (RP) continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer (PCa). Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy (RRP). From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa (T1a-T2c: group 1), and 183 had locally advanced PCa (≥T3a: group 2). The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa (26.2% vs. 17.8%, P=0.91). Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT3 or greater.
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Najafi Anaraki A, Abbasi M, Anvarypour A, Motamed N. The effects of Adding Meperidine to Heavy Intrathecal Lidocaine on Hemodynamic Changes and Blood Loss in Open Prostatectomy: A Randomized Double-Blind Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2012; 37:15-22. [PMID: 23115426 PMCID: PMC3470293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/30/2011] [Accepted: 09/11/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Clinical investigations have reported several anesthetic properties of intrathecal injections of meperidine. The purpose of this study was to investigate the effect of adding meperidine to intrathecal heavy lidocaine on hemodynamic changes and blood loss in patients undergoing elective suprapubic open prostatectomy. METHODS In a randomized double-blind clinical trial, 77 patients candidate for elective suprapubic open prostatectomy were allocated to two equal groups. All patients in the control and experimental groups received heavy lidocaine intrathecally. A low dose of meperidine was added to lidocaine in the experiment group. Changes in blood pressure and heart rate were measured and documented in several intervals. Blood loss, transfusion rate, shivering, nausea, vomiting, need to an analgesic drug, and transient neurologic symptoms were also recorded. RESULTS No significant difference was observed between the two groups in regards to blood pressure changes in operating room. Blood pressure increase was more prevalent among patients of the control group immediately in post-operating period. There were significantly (P<0.0001) less post-operative bleeding and need to transfusion in the experimental group. CONCLUSION Adding low dose of meperidine to lidocaine induces minimal effect on blood pressure change in operating room, but prevent increasing of blood pressure in post-operative period with a reduction of bleeding. TRIAL REGISTRATION NUMBER IRCT138903061936N2.
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Affiliation(s)
- Abdolreza Najafi Anaraki
- Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohamadzaki Abbasi
- Department of Urology, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Abdolrasoul Anvarypour
- Department of Anesthesiology and Intensive Care Unit, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Niloofar Motamed
- Department of Community Medicine, Faculty of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
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Srivastava A, Suy S, Collins SP, Kumar D. Circulating MicroRNA as Biomarkers: An Update in Prostate Cancer. MOLECULAR AND CELLULAR PHARMACOLOGY 2011; 3:115-124. [PMID: 22379500 PMCID: PMC3287394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Prostate cancer (PCa) is the most common non-skin cancer among men. Currently available diagnostic tests for PCa are inadequate in terms of low specificity and poor sensitivity. microRNAs offer a hope to overcome these drawbacks by virtue of their cancer specific expression and high stability. They can readily be detected and quantified in frozen and as well as formalin-fixed paraffin-embedded tissues. Observation of circulating miRNA in serum/plasma samples and other body fluids holds a promise to quickly move from research and provide a biomolecule of clinical relevance and an improvement over presently available biomarkers. This review highlights the potential role of circulating miRNAs as molecular markers for cancer and as targets for therapeutic manipulation. Further, this review summarizes the current understanding of various circulating miRNA with respect to prostate cancer. To conclude, circulating miRNAs are an active area of current investigation and holds promise to serve a wide range of clinical applications and unwrap a new era in cancer diagnosis and therapeutics.
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Affiliation(s)
- Anvesha Srivastava
- Cancer Research Laboratory, Department of Biology, University of the District of Columbia, Washington, DC
| | - Simeng Suy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Sean P. Collins
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Deepak Kumar
- Cancer Research Laboratory, Department of Biology, University of the District of Columbia, Washington, DC
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
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