Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy

Choi, Eun Mi; Na, Sungwon; Choi, Seung Ho; An, Jiwon; Rha, Koon Ho; Oh, Young Jun

doi:10.1016/j.jclinane.2010.08.006

Cited by 86 publications

(71 citation statements)

References 26 publications

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“…They reported that pressure-controlled ventilation had no advantage over volume-controlled ventilation regarding respiratory mechanics or hemodynamics except for its greater compliance and lower peak airway pressure. In this study, the development of hypoxemia during steep Trendelenburg positioning with pneumoperitoneum was related to the increase of dead space ventilation [60]. Potential air, CO 2 , and gas emboli may occur in patients undergoing this procedure, especially in the setting of vascular injury where insufflation pressure may exceed venous pressure.…”

Section: Pulmonary Considerationsmentioning

confidence: 78%

Anesthetic considerations for robotic prostatectomy: a review of the literature

Awad

Walker

Shaikh

et al. 2012

Journal of Clinical Anesthesia

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Section: Pulmonary Considerationsmentioning

confidence: 78%

Anesthetic considerations for robotic prostatectomy: a review of the literature

Awad

Walker

Shaikh

et al. 2012

Journal of Clinical Anesthesia

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“…In the literature, several ventilation strategies including volume control ventilation, pressure control ventilation, recruitment maneuvers, and PEEP application are discussed for the management of ventilation and oxygenation problems caused by increased intraabdominal pressure and head-down position (19)(20)(21)(22)(23). The importance of PEEP application for maintaining adequate gas exchange while preventing ventilator-induced lung injury is especially emphasized (7,10,22,23).…”

Section: Discussionmentioning

confidence: 99%

Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine model*

Bedirli¹,

Emmez²,

Ünal³

et al. 2017

Turk J Med Sci

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IntroductionRobot-assisted laparoscopic surgery has developed greatly and is becoming a standard technique for radical prostatectomy. It is widely preferred for pelvic surgeries because of its important advantages that minimize postoperative morbidity and mortality. Robotic surgeries in the pelvic region, including radical prostatectomy, rectum resection, and gynecologic procedures, usually require a steep Trendelenburg position and carbon dioxide pneumoperitoneum to secure the surgical field. Pneumoperitoneum combined with steep Trendelenburg position may cause significant changes in cardiovascular, respiratory, and neurophysiological parameters (1,2). Both the increase in abdominal pressure as a result of carbon dioxide insufflation and the head-down position have been shown to impair respiratory functions during the procedure by pushing the diaphragm upward and reducing lung volume and respiratory compliance, thus inducing atelectasis formation (3,4).Background/aim: This study was undertaken to evaluate the effects of positive end-expiratory pressure (PEEP) levels on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to determine the appropriate PEEP level during steep Trendelenburg position combined with pneumoperitoneum. Materials and methods:Ten pigs were included in this study. Pneumoperitoneum and Trendelenburg position were maintained and PEEP titration was initiated. Arterial pressure, heart rate, arterial blood gas, ICP, and CPP were recorded at the following time points: baseline (T0), 30 min after positioning and pneumoperitoneum (T1), PEEP 5 (T2), PEEP 10 (T3), PEEP 15 (T4), and PEEP 20 (T5).Results: MAP significantly increased at T1 compared to T0 and decreased at T4 and T5 compared to T1. ICP was 9.5 mmHg and CPP was 69.3 mmHg at T0. CO 2 insufflation and steep Trendelenburg position did not cause any significant difference in ICP and CPP. ICP increased and CPP decreased significantly at T4 and T5 compared to both T0 and T1. PaO 2 and PaO 2 /FiO 2 decreased significantly at T1 and T2 compared to T0, while both increased significantly at T3, T4, and T5 compared to T1. Conclusion:PEEP of 10 cmH 2 O was effective for providing oxygenation while preserving hemodynamic stability, ICP, and CPP in this model.

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“…Pressurecontrolled ventilation was reported to decrease peak airway pressure and increase dynamic compliance and found superior to volume controlled ventilation by Assad et al [35] . But Balick-Weber et al [36] and Choi et al [37] reported that these two ventilation techniques are not superior to each other regarding respiratory mechanics and hemodynamics. Endo-tracheal intubation with either volume or pressure controlled ventilation is the recommended technique, especially for longer operations, because it provides a better control over CO 2 and prevents gastric regurgitation.…”

Section: Pulmonary Complicationsmentioning

confidence: 98%

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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Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy

Cited by 86 publications

References 26 publications

Anesthetic considerations for robotic prostatectomy: a review of the literature

Anesthetic considerations for robotic prostatectomy: a review of the literature

Effects of positive end-expiratory pressure on intracranial pressure during pneumoperitoneum and Trendelenburg position in a porcine model*

Complications of robotic and laparoscopic urologic surgery relevant to anesthesia

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