| Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. | |
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MedLine Citation:
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PMID: 20167583 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The steep (40 degrees ) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to investigate the combined effect of this position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during these procedures. METHODS: Physiological data were recorded during the whole surgical procedure in 31 consecutive patients who underwent robotic endoscopic radical prostatectomy under general anaesthesia. Heart rate, mean arterial pressure, central venous pressure, Sp(o(2)), Pe'(co(2)), P(Plat), tidal volume, compliance, and minute ventilation were monitored and recorded. Arterial samples were obtained to determine the arterial-to-end-tidal CO(2) tension gradient. Continuous regional cerebral tissue oxygen saturation (Sct(o(2))) was determined by near-infrared spectroscopy. RESULTS: Although patients were in the Trendelenburg position, all variables investigated remained within a clinically acceptable range. Cerebral perfusion pressure (CPP) decreased from 77 mm Hg at baseline to 71 mm Hg (P=0.07), and Sct(o(2)) increased from 70% to 73% (P<0.001). Pe'(co(2)) increased from 4.12 to 4.79 kPa (P<0.001) and the arterial-to-Pe'(co(2)) tension difference increased from 1.06 kPa in the normal position to a maximum of 1.41 kPa (P<0.001) after 2 h in the Trendelenburg position. CONCLUSIONS: The combination of the prolonged steep Trendelenburg position and CO(2) pneumoperitoneum was well tolerated. Haemodynamic and pulmonary variables remained within safe limits. Regional cerebral oxygenation was well preserved and CPP remained within the limits between which cerebral blood flow is usually considered to be maintained by cerebral autoregulation. |
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Authors:
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A F Kalmar; L Foubert; J F A Hendrickx; A Mottrie; A Absalom; E P Mortier; M M R F Struys |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-02-18 |
Journal Detail:
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Title: British journal of anaesthesia Volume: 104 ISSN: 1471-6771 ISO Abbreviation: Br J Anaesth Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-15 Completed Date: 2010-04-14 Revised Date: 2010-12-27 |
Medline Journal Info:
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Nlm Unique ID: 0372541 Medline TA: Br J Anaesth Country: England |
Other Details:
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Languages: eng Pagination: 433-9 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, University Medical Center Groningen, University of Groningen, The Netherlands. a.kalmar@anest.umcg.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Anesthesia, General Carbon Dioxide / blood Endoscopy / methods Head-Down Tilt / physiology* Hemodynamics / physiology* Homeostasis / physiology Humans Intracranial Pressure / physiology Lung Compliance / physiology Male Middle Aged Partial Pressure Pneumoperitoneum, Artificial / methods* Prostatectomy / methods* Regional Blood Flow / physiology Robotics / methods* Tidal Volume / physiology |
| Chemical | |
Reg. No./Substance:
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124-38-9/Carbon Dioxide |
| Comments/Corrections | |
Comment In:
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Br J Anaesth. 2011 Jan;106(1):151
[PMID:
21148647
]
Br J Anaesth. 2010 Oct;105(4):548-9 [PMID: 20837727 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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