Does restrictive fluid strategy during robotic pelvic surgeries obtund intraoperative rise in intraocular pressure?

Tosh, Pulak; Krishnankutty, Saritha Valsala; Rajan, Sunil; Nair, Hema Muraleedharan; Puthanveettil, Nitu; Kumar, Lakshmi

doi:10.4103/aer.aer_144_17

Cited by 5 publications

(1 citation statement)

References 12 publications

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“…Restrictive fluid therapy during robotic surgeries is advocated as it minimizes the incidence of cerebral edema and obtunds intraoperative rise in intraocular pressure. 20,21 We report a beneficial effect of restrictive fluid therapy on the lungs.…”

Section: Discussionmentioning

confidence: 91%

Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries

Sethi,

Kathuria,

Samra

et al. 2023

Anaesth. pain intensive care

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Introduction: Robot-assisted laparoscopic pelvic surgeries are minimally invasive techniques that require the patient to be placed in the steep Trendelenburg position. Pneumoperitoneum further increases the risk of postoperative pulmonary complications. We used lung ultrasound score (LUSS) to detect post-operative atelectasis in this subset of patients. Methodology: Patients aged 18 to 70 y with ASA physical status I/II undergoing robot assisted pelvic surgeries in steep Trendelenburg position were enrolled. Patients were mechanically ventilated with 50% oxygen in air with a tidal volume of 6 to 8 ml/kg in volume control mode to maintain an end tidal carbon dioxide at 35−45 mmHg with positive end-expiratory pressure (PEEP) of 5 cmH2O. Ultrasonographic assessment was done; before induction (A), after extubation (F), 12 h (G) and 24 h after surgery (H) by dividing chest into 12 regions. Results: A total of 1152 cine-loops acquired during the study period in 32 patients were analyzed. Incidence of postoperative atelectasis was 87.5% and each lung ultrasound examination required 12.35 ± 4.68 min. Statistically significant fall in PaO2 was recorded at extubation from baseline and intra-operative values (P < 0.0001). Statistically significant difference was established between change in baseline and post-extubation LUSS to the total volume of fluid given (P = 0.002). Conclusion: A high incidence (87.5%) of atelectasis in adults after robot assisted laparoscopic pelvic surgeries was detected using lung ultrasound score. Lung oxygenation decreased significantly after steep Trendelenburg position and extubation. The observed statistical difference in total IV fluids administered between patient subgroups who showed increased ultrasound signs of lung edema from the A period to the F period, although suggestive of association, is no evidence of causation. Abbreviations: ARISCOT- Assess Respiratory Risk in Surgical patients in Catalonia; LUS- Lung Ultrasound; LUSS- Lung Ultrasound Score; OR- Operating room; PEEP- Positive End-Expiratory Pressure Key words: LUSS; Lung ultrasound score; Pneumoperitoneum; Robotic Surgery; Ultrasonography Citation: Sethi S, Kathuria R, Samra T, Saini V, Toshkhani D, Kushal P. Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries. Anaesth. pain intensive care 2023;27(4):573−578; DOI: 10.35975/apic.v27i4.1503 Received: October 28, 2021; Reviewed: June 06, 2022; Accepted: September 17, 2022

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Section: Discussionmentioning

confidence: 91%

Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries

Sethi,

Kathuria,

Samra

et al. 2023

Anaesth. pain intensive care

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The Case for Transperitoneal Robotic Prostatectomy

Abaza¹

2021

Journal of Endourology

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The Effect of Increased Intraocular Pressure During Steep Trendelenburg Positioning in Robotic Prostatectomy and Hysterectomy on Structural and Functional Ocular Parameters

Awad

Bai

Ramadan

et al. 2020

Anesthesia &Amp; Analgesia

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BACKGROUND: Robotic prostatectomy and robotic hysterectomy require steep Trendelenburg positioning. Many authors documented significant increases in intraocular pressure (IOP) during steep Trendelenburg. However, the long-term biological effect of a significant increase in IOP on the structural and functional ocular system is unknown. This study examines the effect of a significant increase in IOP on the visual acuity, retinal nerve fiber layer thickness (RNFLT), and ganglion cell complex (GCC) thickness in 52 patients without preexisting ocular disease of both genders before and 3 months after their procedures. METHODS: This was a prospective cohort study. The total number of patients included was 56, then 3 females and 1 male case were excluded, totaling 28 robotic hysterectomies and 24 robotic prostatectomies were performed. Patients underwent complete eye examination before the procedure and 3 months after, measuring the main outcome of RNFLT and the secondary outcomes of GCC thickness, foveal threshold (FT), mean deviation (MD), and pattern standard deviation (PSD). These outcomes were analyzed using linear mixed-effects models. On the day of surgery, we examined the IOP after induction of anesthesia, at the end of steep Trendelenburg, and in the recovery room. RESULTS: There were significant differences in IOP values at the end of steep Trendelenburg versus after induction and 45–60 minutes post-awakening (P < .001 for both groups). No difference between IOP 45 and 60 minutes post-awakening and IOP after induction was observed in either group. The highest IOPs occurred at the end of the steep Trendelenburg time point for both groups. The mean duration of steep Trendelenburg in robotic prostatectomy was 184.6 minutes (standard deviation [SD] = 30.8), while the mean duration in robotic hysterectomy was 123.0 minutes (SD = 29.8). All ophthalmologic examinations were normal preoperatively and 3 months postoperatively. The ocular parameters in the retina and optic disk did not differ significantly before surgery and 3 months after. CONCLUSIONS: There is a significant increase in IOP during steep Trendelenburg positioning. There was no significant difference in the ocular parameters examined 3 months after the procedure in this cohort.

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Does restrictive fluid strategy during robotic pelvic surgeries obtund intraoperative rise in intraocular pressure?

Cited by 5 publications

References 12 publications

Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries

Lung ultrasonography for detection of atelectasis in adults undergoing robot assisted laparoscopic pelvic surgeries

The Case for Transperitoneal Robotic Prostatectomy

The Effect of Increased Intraocular Pressure During Steep Trendelenburg Positioning in Robotic Prostatectomy and Hysterectomy on Structural and Functional Ocular Parameters

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