Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra- and extrathoracic airways in patients with or without chronic obstructive pulmonary disease

Kılıç, Özkan; Börgers, A.; Köhne, Wiebke; Musch, Michael; Kröpfl, D.; Groeben, Harald

doi:10.1093/bja/aeu322

Cited by 54 publications

(33 citation statements)

References 32 publications

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“…The decreases in FVC, FEV 1 , and PEF were significantly lower in the low V T -PEEP group compared to the high V T -ZEEP group, emphasizing the benefit of PEEP application in the intraoperative period of RALP. Kilic et al [18] stated that postoperative vital capacity and FEV 1 values were reduced in patients without COPD, returning to normal levels only after 5 days. In our patients, we measured pulmonary functions at the 24th postoperative hour.…”

Section: Discussionmentioning

confidence: 99%

Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy

Haliloğlu¹,

Bilgili

Ozdemir

et al. 2017

Med Princ Pract

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Objective: The aim was to compare the effects of low tidal volume (V_T) and moderate positive end-expiratory pressure (PEEP) with high V_T and zero end-expiratory pressure (ZEEP) on postoperative pulmonary functions and oxygenation in patients undergoing robot-assisted laparoscopic radical prostatectomy. Subjects and Methods: Forty-four patients were randomized into low V_T-PEEP and high V_T-ZEEP groups. The patients were ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP in the low V_T-PEEP group and a V_T of 10 mL/kg and 0 cm H₂O PEEP in the high V_T-ZEEP group. Preoperative and postoperative spirometric measurements were done and chest X-rays were evaluated using the radiological atelectasis score (RAS). p < 0.05 was considered statistically signiﬁcant. Results: The intraoperative and postoperative arterial partial pressure of oxygen and arterial oxygen saturation values were significantly higher in the low V_T-PEEP group than in the high V_T-ZEEP group. At all times, the arterial-to-alveolar oxygenation gradients were significantly lower in the low V_T-PEEP group than in the high V_T-ZEEP group. Preoperative RAS were similar in both groups, but the postoperative RAS was significantly lower in the low V_T-PEEP group (p < 0.001). Forced vital capacity, forced expiratory volume in 1 s, and peak expiratory flow rate recorded postoperatively were significantly lower in the high V_T-ZEEP group (p < 0.001). Conclusions: Postoperative pulmonary functions were less impaired in patients ventilated with a V_T of 6 mL/kg and 8 cm H₂O PEEP than in patients ventilated with a V_T of 10 mL/kg and ZEEP.

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Section: Discussionmentioning

confidence: 99%

Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy

Haliloğlu¹,

Bilgili

Ozdemir

et al. 2017

Med Princ Pract

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“…11 In addition, robotic prostatectomy requires steep Trendelenburg positioning that can increase the risk of postoperative upper airway oedema and obstruction. 15 This study was designed to test the hypothesis that deep neuromuscular block with reversal by sugammadex, in contrast to 'routine care' of moderate block with reversal by neostigmine, will result in less postoperative pain, lower insufflation pressures, and improved postoperative outcomes.…”

Section: Editor's Key Pointsmentioning

confidence: 99%

Effect of reversal of deep neuromuscular block with sugammadex or moderate block by neostigmine on shoulder pain in elderly patients undergoing robotic prostatectomy

Williams

Cata

Lasala

et al. 2020

British Journal of Anaesthesia

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Background: For some laparoscopic procedures, deep neuromuscular block has been shown to facilitate lower insufflation pressures and lower patient pain scores, and enhance postoperative recovery. We investigated the impact of deep neuromuscular block and its reversal on postoperative shoulder pain and outcomes after robotic prostate surgery. Methods: Elderly men undergoing robotic prostatectomy were randomised to deep neuromuscular block (target posttetanic twitch of 1e2 at the facial nerve) with sugammadex reversal or moderate neuromuscular block (target 1e2 trainof-four ratio) with neostigmine reversal. The primary endpoint was postoperative shoulder pain. The secondary endpoints included intraoperative insufflation pressure, surgical rating score, incidence of residual neuromuscular block, and postoperative recovery. Results: A total of 50 subjects for each treatment arm were included in the analysis. The degree of neuromuscular block had no effect on the incidence of shoulder pain (deep block group 12% vs moderate block group 10%; P¼1.0) or average insufflation pressure (median [inter-quartile range]) (13.3 [12.5e13.6] mm Hg vs 13.3 [11.7e14] mm Hg, P¼0.86). After surgery, the deep block group had a higher normalised train-of-four ratio (0.98 [0.79e1.11] vs 0.85 [0.74e1.00]; P¼0.008). The presence of postoperative shoulder pain was associated with higher BMI (31.8 [28e33.9] kg m À2 vs 28 [24.8e31.1] kg m À2 ; P¼0.036) and longer insufflation time (186 [156e257] min vs 154 [126e198] min; P¼0.028). Conclusions: The use of deep neuromuscular block during surgery does not decrease postoperative shoulder pain or enhance recovery after robotic prostatectomy. Clinical trial registration: NCT03210376.

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“…69 The required position for many types of robotic procedures is the steep Trendelenburg. [76][77][78] The respiratory and cardiovascular implications of this extreme and exaggerated position have been well described. 49 69 76-78 However, in the majority of patients, including those with chronic respiratory disease and morbid obesity, this can be managed with protective pressure control ventilatory strategies including positive end-expiratory pressure and optimal fluid management, plus invasive lines and vasopressor support in the high-risk patient.…”

Section: Anaesthetic Perspectivesmentioning

confidence: 99%

The evolution of robotic surgery: surgical and anaesthetic aspects

Ashrafian

Clancy

Grover

et al. 2017

British Journal of Anaesthesia

131

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Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems. We examine the challenges, obstacles and limitations of robotic surgery and its future potential including integrated real-time anatomical and immune-histological imaging and data assimilation with improved visualisation, haptic feedback and robot-surgeon interactivity. We consider current evidence, cost-effectiveness and the learning curve in relation to the surgical and anaesthetic journey, and what is required to continue to realise improvements in surgical operative care. The innovative impact of this technology holds the potential to achieve transformative clinical improvements. However, despite over 30 yr of incremental advances it remains formative in its innovative disruption.

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Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra- and extrathoracic airways in patients with or without chronic obstructive pulmonary disease

Cited by 54 publications

References 32 publications

Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy

Low Tidal Volume Positive End-Expiratory Pressure versus High Tidal Volume Zero-Positive End-Expiratory Pressure and Postoperative Pulmonary Functions in Robot-Assisted Laparoscopic Radical Prostatectomy

Effect of reversal of deep neuromuscular block with sugammadex or moderate block by neostigmine on shoulder pain in elderly patients undergoing robotic prostatectomy

The evolution of robotic surgery: surgical and anaesthetic aspects

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