Evaluation of mechanism of increased intracranial pressure with insufflation

Halverson, Amy L.; Buchanan, Rasmus; Jacobs, Lisa K.; Shayani, Vafa; Hunt, Thelma; Riedel, Charles J.; Sackier, Jonathan M.

doi:10.1007/s004649900648

Cited by 140 publications

(84 citation statements)

References 19 publications

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“…3 In addition, previous studies have reported that it causes a significant reduction of cerebral tissue oxygen saturation (Sct O 2 ) in elderly patients 4 and in patients with pre-existing raised intracranial pressure (ICP). 5 Patients presenting for robotic surgery are usually elderly, and are thus patients in whom the procedure may upset the critical balance between cerebral oxygen supply and demand.…”

mentioning

confidence: 99%

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

Kalmar

Foubert

Hendrickx

et al. 2010

British Journal of Anaesthesia

217

133

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mentioning

confidence: 99%

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

Kalmar

Foubert

Hendrickx

et al. 2010

British Journal of Anaesthesia

217

133

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“…Likewise, there are studies that reported that the gas used to augment the severity of bacteriemia plays only a minor role. [47] In conclusion, in the rats with peritonitis, the CO 2 pneumoperitoneum, compared to laparotomy, resulted in a less severe inflammatory response and peritonitis. Therefore, we think that in the cases of generalized peritonitis, surgical procedures for diagnosis and treatment can be carried out successfully, and that this point will be highlighted more by randomized controlled clinical studies for the said purposes.…”

Section: Discussionmentioning

confidence: 83%

The effect of carbondioxide pneumoperitoneum on the severity peritonitis

Uzunköy¹,

Özardalı²,

Çelik³

et al. 2012

Ulus Travma Acil Cerrahi Derg

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AMAÇJeneralize peritonit olgularında hala, laparoskopik girişimlerin güvenilirliği ile ilgili kaygılar devam etmektedir. Bu deneysel çalışmada, deneysel peritonit oluşturulan sı-çanlarda karbondioksit (CO 2 ) pnömoperitonyumun enflematuvar cevap ve peritonit şiddeti üzerine etkilerinin araş-tırılması amaçlandı. GEREÇ VE YÖNTEMÇalışmada 21 Wistar albino cinsi sıçan kullanıldı. Sıçanlar üç gruba ayrıldı. Bunlar; kontrol (grup 1), bakteriyel peritonit oluşturulan grup (grup 2) ve peritonit + CO 2 pnömo-perituan oluşturulan grup (grup 3) idi. İkinci ve üçüncü gruptaki sıçanların periton içine Escherishia coli verilerek peritonit oluşturuldu. Üçüncü gruptaki sıçanlarda CO 2 insuflasyonu ile pnömoperitonyum oluşturuldu. Sıçanlar 24 saat sonra öldürüldü, kan ve karın duvarından periton ör-neği alındı. Tüm gruplarda peritonit şiddet skoru, C-reaktif protein düzeyi ve kanda beyaz küre sayısı değerlendirildi. BULGULARPeritonit şiddet skoru, C-reaktif protein düzeyi ve kan beyaz küre sayısı, ikinci ve üçüncü gruplarda, birinci gruba göre anlamlı düzeyde yüksek bulundu (p<0,05). Üçüncü grupta değerler, ikinci gruptan anlamlı düzeyde düşük bulundu (p<0,05). SONUÇÇalışmamızın sonuçları, CO 2 pnömoperitonyumun Escherishia coli ile peritonit ve sepsis oluşturulan sıçanlarda peritonit şiddetini ve sistemik enflematuvar yanıtı azalttığı-nı göstermiştir.

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“…The combination of steep Trendelenburg and pneumoperitoneum, used in robotic-assisted MIS has been shown increase mean arterial blood pressure, as well as right and left ventricular filling pressures, and pulmonary capillary wedge pressure in both healthy patients and in those with cardiopulmonary disease [17]. In addition, pneumoperitoneum and head-down tilt have both been found to induce intracranial hypertension [18], and in elderly patients to reduce cerebral tissue oxygen saturation [19]. Whether or not these physiologic changes can lead to cardiovascular or neurologic injury in elderly patients undergoing long robotic-assisted MIS procedures has not been well established.…”

Section: Discussionmentioning

confidence: 99%

Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies

Eddib¹,

Hughes²,

Aalto³

et al. 2014

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Objective: To estimate the impact of patient's age on surgical outcomes in patients undergoing robotic hysterectomy. Methods: A retrospective review of prospectively collected cohort data for a consecutive series of patients undergoing gynecologic robotic surgery. Patient's age and perioperative variables were collected from the database, charts, and other hospital records of all patients undergoing robotic hysterectomy. Results: 399 patients underwent robotic surgery for gynecologic disease. 370 patients who were under age 70 were compared with 29 patients who were over age 70. When comparing all patients under age 70 with patients over age 70, the mean age was 48.4 and 77 (P < 0.05), mean BMI was 32.1 and 28.3 kg/m 2 (P < 0.05), mean procedure time was 185 and 211 minutes (min) (P = 0.09), mean console time was 123 and 148 min (P = 0.056), mean OR (Operating room) time was 237 and 273, mean EBL (Estimated blood loss) was 71 and 65 ml (P = 0.74), Hb (Hemoglobin) drop was 1.4 and 1.2 (P = 0.45), uterine weight was 212 and 95 gm (P = 0.98), and length of stay was 1.4 and 1.6 days (P = 0.33) ( Table 1). The patients over age 70, when procedures were combined, had a statistically significant lower mean BMI, uterine weight and longer Operating room (OR) time. However, when stratified by the type of procedure performed, there was no difference in surgery times among those under 70 and over 70 years of age. The elderly patients were more likely to have cancer, which was in almost half the elderly patients, and thus necessitate staging. Thus adding the performance of lymph node dissection likely resulted in the increased length of the surgery time that was noted in the combined group (Tables 1, 2). There were no operative deaths. Conclusions: Advanced age does not appear to be associated with an increased risk of morbidity, or adverse perioperative outcomes in patients undergoing robotic hysterectomy.

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Evaluation of mechanism of increased intracranial pressure with insufflation

Cited by 140 publications

References 19 publications

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

The effect of carbondioxide pneumoperitoneum on the severity peritonitis

Impact of Age on Surgical Outcomes after Robot Assisted Laparoscopic Hysterectomies

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