Effects of long periods of pneumoperitoneum combined with the head-up position on heart rate-corrected QT interval during robotic gastrectomy: an observational study

Abstract

ObjectivePneumoperitoneum and the head-up position reportedly stimulate the sympathetic nervous system, potentially increasing the risk of cardiac arrhythmia. We evaluated the effects of a long duration of pneumoperitoneum in the head-up position on the heart rate-corrected QT (QTc) interval during robotic gastrectomy.MethodsThis prospective observational study involved 28 patients undergoing robotic gastrectomy. The QTc interval was recorded at the following time points: before anaesthetic induction (baseline); 10 minutes after tracheal intubation; 1, 5, 30, 60, and 90 minutes after pneumoperitoneum induction in the head-up position; after pneumoperitoneum desufflation in the supine position; and at the end of surgery. The primary outcome was the QTc interval, which was measured 90 minutes after pneumoperitoneum combined with the head-up position.ResultsCompared with baseline, the QTc interval was significantly prolonged at 1 and 60 minutes after pneumoperitoneum, peaked at 90 minutes, and was sustained and notably prolonged until the end of surgery. However, no considerable haemodynamic changes developed.ConclusionA long period of carbon dioxide pneumoperitoneum application in a head-up position significantly prolonged the QTc interval during robotic gastrectomy. Therefore, diligent care and close monitoring are required for patients who are susceptible to developing ventricular arrhythmia.Trial Registration: Registered at ClinicalTrials.gov; https://clinicaltrials.gov/ct2/show/NCT02604979; Registration number NCT02604979

Robot‐assisted completion gastrectomy preserving interposed jejunum in remnant gastric cancer following a proximal gastrectomy reconstructed by jejunal interposition: A case report

“…Moreover, the intraoperative hemodynamic state is of special concern in elderly patients who are more likely to be affected by the head-up position and longer operative time. 10 Therefore, in the present study, care was taken to ensure that the head-up position did not exceed 15 in elderly patients or in patients with arrhythmia.…”

“…To ensure safety in such technically complicated, robotic procedures, the surgeon ideally has the following experience: (1) more than 20 cases of robotic gastrectomy, including at least one total gastrectomy; and (2) at least one laparoscopic or robotic completion gastrectomy following a distal gastrectomy. Moreover, the intraoperative hemodynamic state is of special concern in elderly patients who are more likely to be affected by the head‐up position and longer operative time 10 . Therefore, in the present study, care was taken to ensure that the head‐up position did not exceed 15° in elderly patients or in patients with arrhythmia.…”

Influence of Deep Neuromuscular Blockade on Perioperative Stress Response in Patients Undergoing Robot-Assisted Gastrectomy: A Prospective Double-Blinded Randomized-Controlled Trial

“…However, this technique requires carbon dioxide (CO 2 ) pneumoperitoneum over 12 mmHg and recommends patients to be in the head-up position for the duration of the surgery for better surgical view, both of which are predisposing conditions for autonomic nervous system imbalance. This situation causes stimulation of sympathetic activity, aggravating the perioperative stress response [3][4][5].…”