BACKGROUND: Several investigations have reported reproducibility for isokinetic single-joint (SJ) knee strength measurements. However, to date, only a few studies have concentrated on multi-joint (MJ) leg strength measurements. OBJECTIVE: This study is the first to investigate reproducibility for MJ leg strength measurements using the IsoMed 2000system, which recently was introduced into the market. METHODS: Peak Force (PF) of forty-one healthy male subjects (mean age: 24.4 years) performing concentric and eccentric MJ leg extension at standardized mean knee-joint angular velocities 40 and 80 • /s (i.e. individual linear foot velocities of 0.12-0.19 and 0.24-0.38 m/s, respectively) was measured in three identical sessions (T1-T3), separated by 10-14 days. Repeated measures analysis of variance (ANOVA) was applied for detection of systematic errors over sessions. Reproducibility was calculated between consecutive pairs of sessions (T1-T2; T2-T3) using intra-class correlation coefficients (ICC 2,1) and standard error of measurement (SEM). RESULTS: Significant increases in mean measurement values of ≈ 2-4% from T1 to T2/T3 could be seen for concentric measurements at 40 • /s and overall eccentric measurements. Reproducibility calculations revealed ICC-values of 0.823-0.956 and 0.911-0.978 with corresponding measures of SEM of 72. 1-175.3 and 49.3-125.3 N for T1-T2 and T2-T3, respectively. CONCLUSIONS: Moderate to high reproducibility was shown for the IsoMed 2000-system in measuring PF during concentric and eccentric isokinetic leg extension. However, as data indicate the presence of an initial practice-based improvement, we recommend the consideration of a familiarisation session in practice.
Background: The aim of this study was to compare the incidence of early postoperative delirium in the postanesthesia care unit (PACU) between robot-assisted radical prostatectomy (RARP) in the extreme Trendelenburg position and open retropubic radical prostatectomy (ORP) in supine position. Methods: Patients were screened for delirium signs 15, 30, 45, and 60 minutes following extubation.Results: PACU delirium was present in 39.3% of RARP (64/163) patients and 41.8% of ORP (77/184) patients. Higher age (OR 1.072, 95%CI: 1.034-1.111, P < .001), total intravenous anesthesia (OR 2.001, 95%CI: 1.243-3.221, P = .004), and anesthesia duration (OR 1.255, 95%CI: 1.067-1.476, P = .006) were associated with PACU delirium, but no association was found between surgical technique and PACU delirium.Conclusion: Compared with inhalational anesthesia, total intravenous anesthesia using propofol-sufentanil, higher age, and longer duration of anesthesia were associated with PACU delirium. Based on these findings, adverse effects on postoperative recovery and delirium signs do not have to be considered in the choice of surgical approach for radical prostatectomy.
Purpose
Surgery in the prolonged extreme Trendelenburg position may lead to elevated intracranial pressure and compromise cerebral hemodynamic regulation. We hypothesized that robot-assisted radical prostatectomy with head-down tilt causes impairment of cerebral autoregulation compared with open retropubic radical prostatectomy in the supine position.
Methods
Patients scheduled for elective radical prostatectomy were included at a tertiary care prostate cancer clinic. Continuous monitoring of the cerebral autoregulation was performed using the correlation method. Based on measurements of cerebral oxygenation with near-infrared spectroscopy and invasive mean arterial blood pressure (MAP), a moving correlation coefficient was calculated to obtain the cerebral oxygenation index as an indicator of cerebral autoregulation. Cerebral autoregulation was measured continuously from induction until recovery from anesthesia.
Results
There was no significant difference in cerebral autoregulation between robot-assisted and open retropubic radical prostatectomy during induction (p = 0.089), intraoperatively (p = 0.162), and during recovery from anesthesia (p = 0.620). Age (B = 0.311 [95% CI 0.039; 0.583], p = 0.025) and a higher difference between baseline MAP and intraoperative MAP (B = 0.200 [95% CI 0.073; 0.327], p = 0.002) were associated with impaired cerebral autoregulation, whereas surgical technique was not (B = 3.339 [95% CI 1.275; 7.952], p = 0.155).
Conclusion
Compared with open radical prostatectomy in the supine position, robot-assisted surgery in the extreme Trendelenburg position with capnoperitoneum did not lead to an impairment of cerebral autoregulation during the perioperative period in our study population.
Trial registration number: DRKS00010014, date of registration: 21.03.2016, retrospectively registered.
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