Influence of Carbon Dioxide on Respiratory Function during Posterior Retroperitoneoscopic Adrenalectomy in Prone Position

Sasagawa, Isoji; Suzuki, Hitoshi; Izumi, Takuji; Shoji, Norifumi; Nakada, Teruhiro; Takaoka, Seiji; Miura, Yoshihide; Hoshi, Hikura; Amagasa, Sumio; Horikawa, Hideo

doi:10.1159/000020023

Cited by 9 publications

(4 citation statements)

References 15 publications

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“…ventilatory and metabolic effects) have seldom been systematically investigated [11,23,24]. Furthermore, most studies were performed at low CO 2 insufflation pressures of 12 to 16 mm Hg [10], not comparable with actual operative settings (use of pressures above 20-25 mm Hg). Comparison between CO 2 insufflation pressures of 15 and 20 mm Hg showed a statistical but not clinically relevant difference in PaCO 2 [11].…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…Yet, a critical analysis of the literature provides limited evidence to support the use of high insufflation pressures, especially when the disadvantages (hemodynamic, pulmonary, and acid-base metabolic effects) are considered [7,10]. Although high pressures increase stroke volume, cardiac output, and mean arterial pressure [11,12], the principal risks include intraoperative hypercapnia and metabolic acidosis [5,10,11,13].…”

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confidence: 99%

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Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

et al. 2020

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Background Insufflation pressures of or in excess of 25 mm Hg CO 2 are routinely used during posterior retroperitoneoscopic adrenalectomy (PRA) in most centres. A critical analysis of the surgical literature provides limited evidence to support this strategy. Objective To determine whether high pressure (≥ 25 mm Hg) compared with lower pressure (< 25 mm Hg) retroperitoneoscopy reduces operating time and complications. Methods A multi-centre retrospective cohort study was performed using data collected over a period of almost one decade (1st November 2008 until 1st February 2018) from surgical centres in Germany. A total of 1032 patients with benign adrenal tumours were identified. We compared patients undergoing PRA with insufflation pressures of < 25 mm Hg (G20 group) versus ≥ 25 mm Hg (G25 group). A propensity score matching analysis was performed using BMI, tumour size and surgeon's experience as independent variables. The main outcomes were (1) the incidence of perioperative complications and (2) the length of operating time. Results The baseline patient characteristics were similar in both groups, with the exception of tumour size, BMI and surgeon's experience in PRA. After propensity score matching, perioperative outcomes, especially perioperative complications (3.7% vs. 5.5% in G20 and G25, respectively; p = 0.335) and operation duration (47 min vs. 45 min in G20 and G25, respectively; p = 0.673), did not significantly differ between the groups. Conclusion Neither patient safety nor operative success was compromised when PRA was performed with insufflation pressures below 25 mm Hg. Prospective studies are required to determine whether an optimal insufflation pressure exists that maximizes patient safety and minimizes the risks of post-surgical complications. Nevertheless, our results call for a careful re-evaluation of the routine use of high insufflation pressures during PRA. In the absence of prospective data, commencing PRA with lower insufflation pressures, with the option of increasing insufflation pressures to counter intraoperative bleeding or exposition difficulties, may represent a reasonable strategy. Keywords Adrenalectomy • Retroperitoneal space • Minimally invasive surgical procedures • Surgery Abbreviations PRA Posterior retroperitoneoscopic adrenalectomy mm Hg Used for mm Hg CO 2 IQR InterQuartile range SD Standard deviation ASA American Society of Anaesthesiologists PaCO2 Partial pressure of carbon dioxide in the arterial blood Minimally invasive surgery is considered to be the gold standard for the surgical removal of benign functioning and non-functioning adrenal tumours [1-3]. Since its first description [4], minimally invasive adrenal surgery has

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Section: Postoperative Complicationsmentioning

confidence: 99%

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confidence: 99%

Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

et al. 2020

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“…Overall, no deleterious cardiovascular effects have been identified up to an insufflation pressure of 25 mmHg; moreover, the intra-abdominal pressure (IAP) is reported to increase by a considerably smaller margin, presumably because the retroperitoneal space is a confined space [1,2,5,9,10]. Similarly, other studies have shown that the impact of retroperitoneal insufflation on the ventilatory system is minimal, relative to that of transperitoneal insufflation [22,25,28].…”

mentioning

confidence: 97%

“…The characteristic retroperitoneal space development pattern at a low insufflation pressure (≤15 mmHg) in dogs has not been observed in humans and pigs. In addition, previous hemodynamic studies in humans and other species involved evaluations at high insufflation pressures (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) in a variety of positions, including the jackknife position and the lateral position with table flexion [5,8,10,22]. Therefore, it can be inferred that different consequences might be observed in healthy dogs positioned in sternal recumbency with the abdomen unsupported.…”

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Cardiopulmonary changes induced by retroperitoneal insufflation in healthy dogs in sternal recumbency with the abdomen unsupported

Son

Jeong

et al. 2020

The Journal of Veterinary Medical Science

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This study assessed the effects of retroperitoneal carbon dioxide (CO 2 ) insufflation on cardiopulmonary variables and intra-abdominal pressure (IAP) in mechanically ventilated dogs in sternal recumbency with the abdomen unsupported, following placement of a positioning kit and towels under the pectoral and pelvic regions. General anesthesia was induced in eight healthy adult male Beagles. A Swan-Ganz catheter was placed in the pulmonary artery via the jugular vein for cardiac output measurements. A Foley urethral catheter was placed to monitor transvesical IAP. A 10 mm balloon blunt-tip trocar was inserted into the retroperitoneal space. With a fixed respiratory rate and tidal volume by mechanical ventilation, insufflation pressure was sequentially increased from 0 to 10 mmHg in 5 mmHg increments, followed by desufflation. All variables were measured before insufflation, 5 min after the establishment of each insufflation pressure, and after desufflation. At 10 mmHg, the IAP was nearly equal to insufflation pressure. Cardiopulmonary function was not compromised at any point, although the cardiac index (CI), heart rate, mean arterial pressure (MAP), and mean pulmonary arterial pressure increased within normal ranges. End-tidal CO 2 concentration, arterial CO 2 partial pressure, and oxygen delivery index (DO 2 I) increased, whereas pH decreased, at 10 mmHg. CI, MAP, and DO 2 I did not recover to baseline after decompression. Thus, retroperitoneal CO 2 insufflation up to 10 mmHg is well tolerated by mechanically ventilated dogs positioned in sternal recumbency with the abdomen unsupported, although sympathetic changes may occur with an insufflation pressure increase.

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Posterior Retroperitoneoscopic Adrenalectomy

Walz¹

2005

Adrenal Glands

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Influence of Carbon Dioxide on Respiratory Function during Posterior Retroperitoneoscopic Adrenalectomy in Prone Position

Cited by 9 publications

References 15 publications

Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

Insufflation pressure above 25 mm Hg confers no additional benefit over lower pressure insufflation during posterior retroperitoneoscopic adrenalectomy: a retrospective multi-centre propensity score-matched analysis

Cardiopulmonary changes induced by retroperitoneal insufflation in healthy dogs in sternal recumbency with the abdomen unsupported

Posterior Retroperitoneoscopic Adrenalectomy

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