Cerebral haemodynamic physiology during steep Trendelenburg position and CO2 pneumoperitoneum

Kalmar, Alain; Dewaele, Frank; Foubert, L.; Hendrickx, Jan F. A.; Heeremans, E. H.; Struys, Michel; Absalom, Anthony

doi:10.1093/bja/aer448

Cited by 55 publications

(35 citation statements)

References 20 publications

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“…Measurement of cerebral blood flow can be assessed by transcranial Doppler measurements of both anterior and posterior cerebral circulation. The benefit of transcranial Doppler in this regard has been proven (11,12). The present study was designed by accepting the cerebral blood flow of the patients as normal and considering that both anterior and posterior blood supply of the brain was natural.…”

Section: Discussionmentioning

confidence: 99%

Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy

Saraçoğlu¹,

Altun²,

Yavru³

et al. 2016

Turk J Anaesth Reanim

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Amaç: Boyun ekstansiyonu intra ve ekstra kranial arterlerde kan akışını belirlemede yardımcı olabilir ama tartışmalı bir konudur. Biz tiroid ameliyatı sırasında baş pozisyonuna bağlı olarak oluşan beyin kan akımı değişikliklerini karotis Doppler incelemesi ve rejyonel oksijen saturasyonundaki değişiklik ile göstermeyi amaçladık.Yöntemler: Çalışmaya 30 hasta alındı. Hastalara tiroidektomi için son pozisyon hali olan 30 ° semi Fowler pozisyonunda baş ve boyun ekstansiyonda olacak şekilde pozisyon verildi. Common karotis arterdeki tepe sistolik hız, ortalama hız, arteryel çap ve kan akım hacmindeki değişiklikler hesaplandı. Her iki taraf bölgesel beyin oksijen saturasyon değerleri sürekli olarak kaydedildi. Bulgular:Ameliyatın sonunda common karotis arterdeki tepe sistolik hız, ortalama hız ve kan akım hacmi başlangıçtaki bazal değerlere göre anlamlı derecede azalmış olarak saptandı (p<0,001). Heriki sol ve sağ serebral oksimetri değerlerinde indüksiyon sonrasında anlamlı olarak artış gözlendi ve artmış serebral oksimetri değerleri operasyon sonunda kalıcı olarak devam etti (p<0,001). Indüksiyon sonrası ve ameliyat sonunda common karotis arterde tepe sistolik hız, ortalama hız, arteryel çap ve kan akım hacminde gözlenen değişiklikler yaş, vücut kitle indeksi, ameliyat süresi ve anestezi süresiyle ilişkili bulunmadı.Sonuç: Tiroidektomi için verilen baş ve boyun ekstansiyonu karotis kan akımı ve beyin oksijenizasyonunu kademeli olarak olumsuz olarak etkilemekte ve özellikle ameliyat sonunda belirgin hale gelmektedir. Sonuç olarak, serebral perfüzyon basıncını korumak ve serebral kan akımının devamlılığını sağlamak önemlidir. Anahtar kelimeler: Kan akımı, serebral oksijenizasyon, tiroidektomiObjective: Determining the blood flow through intra and extra-cranial arteries during neck extension may be helpful but is a controversial issue. We aimed to elucidate the changes in cerebral blood flow related to head positioning during thyroid surgery by carotid Doppler examination and regional oxygen saturation variations. Methods:Thirty patients were recruited to the study. Patients were positioned with a final position of thyroidectomy consisting a 30° semi Fowler with the extension of neck and head. Values of peak systolic velocity, average velocity, arterial diameter and blood flow volume of the common carotid artery were calculated. Bilateral regional cerebral oxygen saturation were monitored continuously. Results:At the end of the operation, peak systolic velocity, average velocity and blood flowvolume of the common carotid artery decreased significantly compared to the baseline measurement (p<0.001). Both left and right cerebral oximetry measurements showed a significant increase after induction and the increased oxymetric values persisted at the end of the operation (p<0.001). Age, body mass index, surgical duration and anaesthesia duration were found not to be correlated with the changes occurred in the values of peak systolic velocity, average velocity, arterial diameter, blood flow volume of the common carotid artery...

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Section: Discussionmentioning

confidence: 99%

Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy

Saraçoğlu¹,

Altun²,

Yavru³

et al. 2016

Turk J Anaesth Reanim

View full text Add to dashboard Cite

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“…Jugular venous oxygen saturation does not seem to reflect brain oxygenation better than rSO 2 in this condition [42]. This condition was also not found to compromise cerebral perfusion [43,44]. Most importantly, all of these non-physiological conditions were still within normal limits, and therefore well tolerated by most patients [34,44].…”

Section: Prostatectomymentioning

confidence: 75%

Anesthetic Considerations with Robotic Surgery

Giordano

Gravenstein

2017

Atlas of Robotic Urologic Surgery

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Review ArticleRecently, demand for minimally invasive surgery has increased greatly. As a result, robot-assisted techniques have gained in popularity, because they overcome several of the shortcomings of conventional laparoscopic techniques. However, robotic surgery may require innovations with regard to patient positioning and the overall arrangement of operative equipment and personnel, which may go against the conservative nature of anesthesia care. Anesthesiologists should become familiar with these changes by learning the basic features of robotic surgical systems to offer better anesthetic care and promote patient safety. (Korean J Anesthesiol 2014; 66: 3-11)

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“…Also combining pneumoperitoneum with Trendelenburg increases the ICP further and this may hinder cerebral oxygenation [26] . Kalmar et al [27] examined patients undergoing RALRP which were exposed to prolonged steep Trendelenburg position and CO 2 pneumoperitoneum and suggested that it does not compromise cerebral perfusion. Though, it is advised to keep the patient in normocapnic range because regional cerebral oxygen saturation (rSO 2 ) is correlated with the increase in partial pressure of CO 2 (PaCO 2 ).…”

Section: Effects On Neurological Systemmentioning

confidence: 99%

Complications of robotic and laparoscopic urologic surgery relevant to anesthesia

Arslan¹,

Özgök²

2018

MIS

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How to cite this article: Arslan ME, Özgök A. Complications of robotic and laparoscopic urologic surgery relevant to anesthesia. AbstractTechnology keeps advancing in this era allowing surgery to become less invasive in many surgical sciences. Besides these technological advances, minimally invasive procedures such as laparoscopy and robotic assisted laparoscopy are preferred widely around the globe by both surgeons and patients. Because of the increasing demand to laparoscopy and robotic surgery, anesthetists also should adapt to these specific surgical procedures. Carbon dioxide (CO 2 ) insufflation is applied in these procedures in order to provide working space and exposure to target organs. CO 2 insufflation (pneumoperitoneum if applied intrabdominally) and positional maneuvers such as steep Trendelenburg position is used in urologic laparoscopy and robotic surgery, which have vital effects on patient's physiology regarding cardiovascular, respiratory, renal, ocular and neurological systems. Special positions and unique surgical tools used in these procedures may hinder vital interventions such as cardiopulmonary resuscitation and open conversion. Comprehension of these pathophysiological effects and specific considerations is crucial to detect, to prevent and to manage serious complications that may occur during surgery.

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Cerebral haemodynamic physiology during steep Trendelenburg position and CO2 pneumoperitoneum

Abstract: Prolonged steep Trendelenburg positioning and CO(2) pneumoperitoneum does not compromise cerebral perfusion. ZFP and eCPP are reliable variables for assessing brain perfusion during prolonged steep Trendelenburg positioning.

Cited by 55 publications

References 20 publications

Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy

Effects of Head Position on Cerebral Oxygenation and Blood Flow Velocity During Thyroidectomy

Anesthetic Considerations with Robotic Surgery

Complications of robotic and laparoscopic urologic surgery relevant to anesthesia

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