Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery

Herling, Suzanne Forsyth; Dreijer, Bjørn; Lam, Gitte Wrist; Thomsen, Thordis; Møller, Ann Merete

doi:10.1002/14651858.cd011387.pub2

Cited by 40 publications

(42 citation statements)

References 43 publications

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“…There is some evidence that propofol may prevent an increase in intraocular pressure after pneumoperitoneum and steep Trendelenburg positioning compared with sevoflurane. However, the clinical relevance of this finding in terms of reducing the incidence of ocular complications is unclear 63 .…”

Section: (D) Ocular Injuriesmentioning

confidence: 99%

Anaesthetic Issues in Robotic-Assisted Minimally Invasive Surgery

Pathirana

Kam

2018

Anaesth Intensive Care

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Over the past decade there has been an exponential increase in the number of robotic-assisted surgical procedures performed in Australia and internationally. Despite this growth, there are no level I or II studies examining the anaesthetic implications of these procedures. Available observational studies provide insight into the significant challenges for the anaesthetist. Most anaesthetic considerations overlap with those of non-robotic surgery. However, issues with limited patient access and extremes of positioning resulting in physiological disturbances and risk of injury are consistently demonstrated concerns specific to robotic-assisted procedures.

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Section: (D) Ocular Injuriesmentioning

confidence: 99%

Anaesthetic Issues in Robotic-Assisted Minimally Invasive Surgery

Pathirana

Kam

2018

Anaesth Intensive Care

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“…Despite the advantages of TIVA in terms of PONV and recovery times, there currently remains limited evidence to make recommendations for its use in all types of robotic surgery. 83 Postoperative analgesia may be improved with neuroaxial techniques such as intrathecal opioids as reduced systemic opiate use, reduced pain scores and increased patient and nursing staff satisfaction have been demonstrated with this approach. 70 71 Oedema can become problematic, particularly in dependent areas after long surgeries in the steep head down position.…”

Section: Anaesthetic Perspectivesmentioning

confidence: 99%

The evolution of robotic surgery: surgical and anaesthetic aspects

Ashrafian

Clancy

Grover

et al. 2017

British Journal of Anaesthesia

124

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Robotic surgery pushes the frontiers of innovation in healthcare technology towards improved clinical outcomes. We discuss the evolution to five generations of robotic surgical platforms including stereotactic, endoscopic, bioinspired, microbots on the millimetre scale, and the future development of autonomous systems. We examine the challenges, obstacles and limitations of robotic surgery and its future potential including integrated real-time anatomical and immune-histological imaging and data assimilation with improved visualisation, haptic feedback and robot-surgeon interactivity. We consider current evidence, cost-effectiveness and the learning curve in relation to the surgical and anaesthetic journey, and what is required to continue to realise improvements in surgical operative care. The innovative impact of this technology holds the potential to achieve transformative clinical improvements. However, despite over 30 yr of incremental advances it remains formative in its innovative disruption.

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“…However, the specific neural mechanisms underlying amnesia and loss of consciousness, including when these phenomena are induced by GA, remain controversial [ 11 – 13 ]. In addition, which method for GA (inhaled anaesthetics vs. TIVA) that should be preferred is a topic of ongoing discussion among anaesthesiologists [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Neuroplasticity induced by general anaesthesia: study protocol for a randomised cross-over clinical trial exploring the effects of sevoflurane and propofol on the brain – A 3-T magnetic resonance imaging study of healthy volunteers

Madsen

Møller

Olsen

et al. 2020

Trials

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Background Although used extensively worldwide, the effects of general anaesthesia on the human brain remain largely elusive. Moreover, general anaesthesia may contribute to serious conditions or adverse events such as postoperative cognitive dysfunction and delirium. To understand the basic mechanisms of general anaesthesia, this project aims to study and compare possible de novo neuroplastic changes induced by two commonly used types of general anaesthesia, i.e. inhalation anaesthesia by sevoflurane and intravenously administered anaesthesia by propofol. In addition, we wish to to explore possible associations between neuroplastic changes, neuropsychological adverse effects and subjective changes in fatigue and well-being. Methods This is a randomised, participant- and assessor-blinded, cross-over clinical trial. Thirty healthy volunteers (male:female ratio 1:1) will be randomised to general anaesthesia by either sevoflurane or propofol. Multimodal magnetic resonance imaging (MRI) of the brain will be performed before and after general anaesthesia and repeated after 1 and 8 days. Each magnetic resonance imaging session will be accompanied by cognitive testing and questionnaires on fatigue and well-being. After a wash-out period of 4 weeks, the volunteers will receive the other type of anaesthetic (sevoflurane or propofol), followed by the same series of tests. Primary outcomes: changes in T1-weighted 3D anatomy and diffusion tensor imaging. Secondary outcomes: changes in resting-state functional magnetic resonance imaging, fatigue, well-being, cognitive function, correlations between magnetic resonance imaging findings and the clinical outcomes (questionnaires and cognitive function). Exploratory outcomes: changes in cerebral perfusion and oxygen metabolism, lactate, and response to visual stimuli. Discussion To the best of our knowledge, this is the most extensive and advanced series of studies with head-to-head comparison of two widely used methods for general anaesthesia. Recruitment was initiated in September 2019. Trial registration Approved by the Research Ethics Committee in the Capital Region of Denmark, ref. H-18028925 (6 September 2018). EudraCT and Danish Medicines Agency: 2018-001252-35 (23 March 2018). www.clinicaltrials.gov, ID: NCT04125121. Retrospectively registered on 10 October 2019.

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Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery

Cited by 40 publications

References 43 publications

Anaesthetic Issues in Robotic-Assisted Minimally Invasive Surgery

Anaesthetic Issues in Robotic-Assisted Minimally Invasive Surgery

The evolution of robotic surgery: surgical and anaesthetic aspects

Neuroplasticity induced by general anaesthesia: study protocol for a randomised cross-over clinical trial exploring the effects of sevoflurane and propofol on the brain – A 3-T magnetic resonance imaging study of healthy volunteers

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