Adverse events related to Trendelenburg position during laparoscopic surgery: recommendations and review of the literature

Arvizo, Cynthia; Mehta, Sumit; Yunker, Amanda

doi:10.1097/gco.0000000000000471

Cited by 37 publications

(36 citation statements)

References 54 publications

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“…In comparison with the open surgical technique (ORP), robot‐assisted radical prostatectomy (RARP) has been discussed to be superior with respect to postoperative complications, postoperative recovery, and quality of life with similar oncological and functional urological outcomes . To allow for optimal visualization and access to the surgical field RARP requires a 30 to 45° head‐down tilt with capnoperitoneum . Although well tolerated by the majority of patients, surgery in the Trendelenburg position may substantially impair cardiovascular and pulmonary function .…”

Section: Introductionmentioning

confidence: 99%

“…To allow for optimal visualization and access to the surgical field RARP requires a 30 to 45° head‐down tilt with capnoperitoneum . Although well tolerated by the majority of patients, surgery in the Trendelenburg position may substantially impair cardiovascular and pulmonary function . Increased venous return, resulting from the effect of gravity in the head‐down position in combination with pneumoperitoneum, leads to an elevation of central venous pressure and mean arterial pressure followed by a transient increase of cardiac output and systemic vascular resistance .…”

Section: Introductionmentioning

confidence: 99%

“…Although well tolerated by the majority of patients, surgery in the Trendelenburg position may substantially impair cardiovascular and pulmonary function . Increased venous return, resulting from the effect of gravity in the head‐down position in combination with pneumoperitoneum, leads to an elevation of central venous pressure and mean arterial pressure followed by a transient increase of cardiac output and systemic vascular resistance . Reduced cerebral autoregulatory capacity has been reported during surgery in the extreme Trendelenburg position .…”

Section: Introductionmentioning

confidence: 99%

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Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

Beck

Hoop

Ragab

et al. 2020

Robotics Computer Surgery

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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.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

Beck

Hoop

Ragab

et al. 2020

Robotics Computer Surgery

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“…Intraoperative prone and steep Trendelenburg positions are known risk factors for the development of postoperative visual loss attributed to ION and retinal ischemia. 6,7 We hypothesize that prolonged surgical resection, fluid resuscitation, and steep Trendelenburg position in the presence of a known large pituitary macroadenoma led to bilateral cavernous sinus syndrome in this patient. It is plausible that pituitary sella venous drainage was partially impaired by the macroadenoma, and placement in the Trendelenburg position along with over 6 L of intravascular volume replacement resulted in an increase in cerebral venous pressure that exacerbated the venous obstruction leading to further edema surrounding the cavernous sinus.…”

Section: Discussionmentioning

confidence: 91%

Bilateral Cavernous Sinus Syndrome, Pituitary Macroadenoma, and Postoperative Loss of Vision: A Case Report

Moldan

Stewart²,

Kor³

et al. 2019

A&A Practice

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Postoperative vision loss is a rare complication. When visual loss does occur, it is rarely associated with ophthalmoplegia. We report a case of postoperative bilateral visual field deficits with concomitant complete bilateral ophthalmoplegia in a patient with a known pituitary macroadenoma after surgical excision of a small cell carcinoma of the bladder. Emergency postoperative imaging showed that the macroadenoma had increased in size and was associated with new right optic nerve edema. The patient underwent urgent excision of the macroadenoma 5 days after the onset of symptoms. Visual field deficits and associated ophthalmoplegia had completely resolved at 3-month follow-up.

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“…Limited data exist regarding the physiologic effects of pneumoperitoneum and Trendelenburg position on patients who are obese [22]. By using a noninvasive CO monitor, this study provides an insight into the cardiovascular response to CO 2 peritoneal insufflation and the steep Trendelenburg position that occurs during MIS for endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Function and Hemodynamic Changes during Minimally Invasive Hysterectomy with Pneumoperitoneum and Steep Trendelenburg Position for Patients with Endometrial Cancer Who Are Obese

Laskov¹,

Alpern²,

Ronel³

et al. 2021

Journal of Minimally Invasive Gynecology

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To assess the effect of carbon dioxide (CO 2) pneumoperitoneum and steep Trendelenburg position on patients' cardiac function and hemodynamics during minimally invasive staging surgery for endometrial cancer. Design: Single-center prospective longitudinal study. Setting: University-affiliated tertiary hospital. Patients: Patients with endometrial cancer undergoing minimally invasive surgery. Interventions: After consent, the patients' hemodynamic parameters were assessed by the Non-Invasive Cardiac System (NI Medical, Petah Tikva, Israel) at 5 time points: before general anesthesia, after induction of general anesthesia, after CO 2 insufflation of the peritoneum, after steep Trendelenburg position, and at the end of surgery. Measurements and Main Results: Twenty-three women were recruited. The median age of the patients was 68 years (interquartile range [IQR] 62−75), with a median body mass index of 34.9 kg/m 2 (IQR 31.2−39.5) and an American Society of Anesthesiologists score ≥2. The initial median mean arterial pressure was 108 mmHg (IQR 101−113), and the baseline median cardiac output was 7.2 L/min (IQR 5.6−8.7). The median mean arterial pressure significantly decreased by 18% after insufflation (p = .001), again after Trendelenburg position (p = .003), and did not fully recover at the end of surgery in comparison with the preanesthesia baseline (p = .001). The median stroke volume significantly decreased by 17% after insufflation compared with the baseline (p = .01) and then gradually recovered to the baseline levels by the end of surgery. The median cardiac power significantly decreased by 35% after insufflation (0.009), remained low during Trendelenburg position (p = .009), and recovered by the end of surgery to 18% below the baseline levels (p = .035). Conclusion: Significant hemodynamic changes occur during minimally invasive staging surgery for endometrial cancer. CO 2 insufflation is accompanied by the most dramatic hemodynamic deterioration during surgery, and this does not get affected much with Trendelenburg. Knowledge of the hemodynamic values of women classified as high risk when using a noninvasive technique during surgery is obtainable and may assist both surgeon and anesthesiologist to ensure a safer procedure.

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Adverse events related to Trendelenburg position during laparoscopic surgery: recommendations and review of the literature

Abstract: This review summarizes possible complications related to the Trendelenburg position and current evidence regarding interventions to minimize the risk of complications.

Cited by 37 publications

References 54 publications

Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

Bilateral Cavernous Sinus Syndrome, Pituitary Macroadenoma, and Postoperative Loss of Vision: A Case Report

Cardiac Function and Hemodynamic Changes during Minimally Invasive Hysterectomy with Pneumoperitoneum and Steep Trendelenburg Position for Patients with Endometrial Cancer Who Are Obese

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