Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2013.10.011
Brazilian Journal of Anesthesiology
Scientific Article

Robotic prostatectomy: the anesthetist's view for robotic urological surgeries, a prospective study,

Prostatectomia robótica: análise anestesiológica de cirurgias urológicas robóticas: estudo prospectivo,

Menekse Oksar; Ziya Akbulut; Hakan Ocal; Mevlana Derya Balbay; Orhan Kanbak

http://dx.doi.org/10.1016/j.bjane.2013.10.011 Braz J Anesthesiol, vol.64, n5, p.307-313, 2014
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Abstract

Background and objectives:Although many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room.Methods:Fifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions.Results:Fifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits.Conclusion:Respiratory acidosis and "upper airway obstruction-like" clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study.

Keywords

Robotic surgery, Prostatectomy, Urological surgery

Resumo

Justificativa e objetivos:Embora muitas características da prostatectomia robótica sejam semelhantes àquelas de laparoscopias urológicas convencionais (como a prostatectomia por laparoscopia), o procedimento está associado a alguns inconvenientes, incluindo acesso intravenoso limitado, tempo cirúrgico relativamente longo, posição de Trendelenburg profunda e pressão intra-abdominal alta. O objetivo principal foi descrever as alterações respiratória e hemodinâmica e as complicações relacionadas à pressão intra-abdominal elevada e à posição de Trendelenburg profunda em pacientes submetidos à prostatectomia robótica. O objetivo secundário foi revelar critérios seguros de alta do centro cirúrgico.Métodos:Foram inscritos prospectivamente 53 pacientes submetidos à prostatectomia robótica entre dezembro de 2009 e janeiro de 2011. As medidas de desfecho primário foram: monitoramento não invasivo, monitoramento invasivo e gasometria feita em decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg + pneumoperitônio (T2), Trendelenburg pré-desinsuflação (T3), Trendelenburg pós-desinsuflação (T4) e posições supinas (T5).Resultados:O principal desafio clínico em nosso grupo de estudo foi a escolha da estratégia de ventilação para controlar a acidose respiratória, que é detectada por meio da pressão de dióxido de carbono expirado e da gasometria. Além disso, a pressão arterial média permaneceu inalterada e a frequência cardíaca diminuiu significativamente e precisou de intervenção. Os valores da pressão venosa central também estavam acima dos limites normais.Conclusão:A acidose respiratória e sintomas clínicos "semelhantes à obstrução das vias aéreas"foram os principais desafios associados aos procedimentos de prostatectomia robótica.

Palavras-chave

Cirurgia robótica, Prostatectomia, Cirurgia urológica

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