BACKGROUND:Robot-assisted laparoscopic radical prostatectomy (RALP) requires a steep Trendelenburg position and CO2 pneumoperitoneum for several hours to secure the surgical visual field. The present study was performed to investigate the influence of each angle of Trendelenburg position during RALP on cardiovascular and respiratory homeostasis. METHODS:Forty-seven ASA physical status 1 and 2 patients underwentopen retropubic radical prostatectomy (RRP) or RALP. Patients receivingRALP were randomized to undergo the operation in the 20°, 25° or 30° Trendelenburg position. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end-tidal CO2 pressure (PetCO2 ), tidal volume (Vt), peak inspiratory pressure (PIP) and dynamic compliance (Cdyn) were recorded during the operation. RESULTS:Angle of head-down tilt was significantly correlated with MAP, PIP and Cdyn, but not with HR, RR or PetCO2 . MAP decreased gradually over time in each group in the Trendelenburg position with pneumoperitoneum. As the angle of head-down tilt became stronger, MAP, RR, PetCO2 and PIP tended to increase and Cdyn tended to decrease. CONCLUSIONS: This study demonstrated that the degree of the head-down angle at RALP affected the cardiovascular and respiratory parameters. Pneumoperitoneum with head-down position in RALP influenced the cardiovascular and respiratory system to a greater extent than RRP, and these effects were stronger with deeper head-down angle.
RCT Entities:
BACKGROUND: Robot-assisted laparoscopic radical prostatectomy (RALP) requires a steep Trendelenburg position and CO2 pneumoperitoneum for several hours to secure the surgical visual field. The present study was performed to investigate the influence of each angle of Trendelenburg position during RALP on cardiovascular and respiratory homeostasis. METHODS: Forty-seven ASA physical status 1 and 2 patients underwent open retropubic radical prostatectomy (RRP) or RALP. Patients receiving RALP were randomized to undergo the operation in the 20°, 25° or 30° Trendelenburg position. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end-tidal CO2 pressure (PetCO2 ), tidal volume (Vt), peak inspiratory pressure (PIP) and dynamic compliance (Cdyn) were recorded during the operation. RESULTS: Angle of head-down tilt was significantly correlated with MAP, PIP and Cdyn, but not with HR, RR or PetCO2 . MAP decreased gradually over time in each group in the Trendelenburg position with pneumoperitoneum. As the angle of head-down tilt became stronger, MAP, RR, PetCO2 and PIP tended to increase and Cdyn tended to decrease. CONCLUSIONS: This study demonstrated that the degree of the head-down angle at RALP affected the cardiovascular and respiratory parameters. Pneumoperitoneum with head-down position in RALP influenced the cardiovascular and respiratory system to a greater extent than RRP, and these effects were stronger with deeper head-down angle.
Authors: Alice M Couwenberg; Maarten J P Burbach; Anke B Smits; Marco Van Vulpen; Wilhemina M U Van Grevenstein; Peter G Noordzij; Helena M Verkooijen Journal: Trials Date: 2016-03-10 Impact factor: 2.279
Authors: Na Young Kim; Dong Woo Han; Jae Chul Koh; Koon Ho Rha; Jung Hwa Hong; Jong Min Park; So Yeon Kim Journal: Medicine (Baltimore) Date: 2016-05 Impact factor: 1.889
Authors: Fouad G Souki; Yiliam F Rodriguez-Blanco; Sravankumar Reddy Polu; Scott Eber; Keith A Candiotti Journal: BMC Anesthesiol Date: 2018-08-21 Impact factor: 2.217
Authors: Ke Chen; Lizhen Wang; Qing Wang; Xuesheng Liu; Yao Lu; Yuanhai Li; Gordon Tin Chun Wong Journal: Medicine (Baltimore) Date: 2019-05 Impact factor: 1.817