Hemodynamic outcome of different ventilation modes in laparoscopic surgery with exaggerated trendelenburg: a randomised controlled trial
Resultado hemodinâmico de diferentes modos de ventilação em cirurgia laparoscópica com Trendelenburg exagerado: um ensaio clínico randomizado
Hakan Yılmaz; Baturay Kansu Kazbek; Ülkü Ceren Köksoy; Ahmet Murat Gül; Perihan Ekmekçi; Gamze Sinem Çağlar; Filiz Tüzüner
Abstract
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Resumo
Objetivo: Comparar os efeitos hemodinâmicos de dois modos diferentes de ventilação (volume controlado e volume controlado por pressão garantido) em pacientes submetidas a cirurgias ginecológicas laparoscópicas com posição de Trendelenburg exagerada.
Métodos: Trinta pacientes submetidos a operações de ginecologia laparoscópica foram ventilados usando o modo de volume controlado por volume (Grupo CV) ou o modo de volume garantido por pressão controlada (Grupo VGPC) (n = 15 para ambos os grupos). As variáveis hemodinâmicas foram medidas usando o Método Analítico de Registro de Pressão por canulação da artéria radial, além das pressões máximas e médias das vias aéreas e volume corrente expirado.
Resultados: O único achado notável foi um índice cardíaco mais estável no Grupo VGPC, onde outros parâmetros hemodinâmicos foram semelhantes. O volume corrente expirado aumentou no Grupo CV, enquanto o pico de pressão nas vias aéreas foi menor no Grupo VGPC.
Conclusão: o VGPC causa menos perturbações hemodinâmicas medidas pelo Método Analítico de Registro de Pressão (MARP) e permite melhor controle hemodinâmico intraoperatório na posição de Trendelenburg exagerada em cirurgia laparoscópica.
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References
1 Wang JP, Wang HB, Liu YJ, et al. Comparison of pressure- and volume-controlled ventilation in laparoscopic surgery: A meta-analysis of randomized controlled trial. Clin Invest Med. 2015;38:e119-41.
2 Patil S, Koyyalamudi P, Robertson C, et al. Physiologic effects of pneumoperitoneum and positioning. In: Kaye A, Urman R, editors. Perioperative management in robotic surgery. Cambridge: Cambridge University Press; 2017. p. 20-8.
3 Romagnoli S, Franchi F, Ricci Z, et al. The pressure recording analytical method (PRAM): Technical concepts and literature review. J Cardiothorac Vasc Anesth. 2017;31:1460-70.
4 Oğurlu M, Kü¸cük M, Bilgin F, et al. Pressure-controlled vs volume-controlled ventilation during laparoscopic gynecologic surgery. J Minim Invasive Gynecol. 2010;17:295-300.
5 Kim MS, Soh S, Kim MY, et al. Comparisons of pressure-controlled ventilation with volume guarantee and volume-controlled 1:1 equal ratio ventilation on oxygenation and respiratory mechanics during robot-assisted laparoscopic radical prostatectomy: A randomized-controlled trial. Int J Med Sci. 2018;15:1522-9.
6 Dion JM, McKee C, Tobias JD, et al. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques. J Clin Monit Comput. 2015;29:183-6.
7 Choi EM, Na S, Choi SH, et al. Comparison of volume-controlled and pressure-controlled ventilation in steep trendelenburg position for robot-assisted laparoscopic radical prostatectomy. J Clin Anesth. 2011;23:183-8.
8 Assad OM, El Sayed AA, Khalil MA. Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in trendelen-burg position. J Clin Anesth. 2016;34:55-61.
9 Dion JM, McKee C, Tobias JD, et al. Ventilation during laparoscopic-assisted bariatric surgery: volume-controlled, pressure-controlled or volume-guaranteed pressure-regulated modes. Int J Clin Exp Med. 2014;7:2242-7.
10 Hendrickx J, Peyton P, Carette R, et al. Inhaled anaesthetics and nitrous oxide: Complexities overlooked: things may not be what they seem. Eur J Anaesthesiol. 2016;33:611-9.
11 Li ECK, Balbuena LD, Gamble JJ. Evaluation of nitrous oxide in the gas mixture for anesthesia II (ENIGMA II) revisited: Patients still vomiting. Anesthesiology. 2017;127:204-5.
12 Sen O, Erdogan Doventas Y. Effects of different levels of endexpiratory pressure on hemodynamic, respiratory mechanics and systemic stress response during laparoscopic cholecystectomy. Braz J Anesthesiol. 2017;67:28-34.
13 Ukere A, Marz A, Wodack KH, et al. Perioperative assessment of regional ventilation during changing body positions and ventilation conditions by electrical impedance tomography. Br J Anaesth. 2016;117:228-35.
14 Sprung J, Whalley DG, Falcone T, et al. The effects of tidal volume and respiratory rate on oxygenation and respiratory mechanics during laparoscopy in morbidly obese patients. Anesth Analg. 2003;97:268-74.
15 Oksar M, Akbulut Z, Ocal H, et al. Anesthetic considerations for robotic cystectomy: a prospective study. Braz J Anesthesiol. 2014;64:109-15.
16 Donati A, Carsetti A, Tondi S, et al. Thermodilution vs pressure recording analytical method in hemodynamic stabilized patients. J Crit Care. 2014;29:260-4.
17 Romano SM, Pistolesi M. Assessment of cardiac output from systemic arterial pressure in humans. Crit Care Med. 2002;30:1834-41.
18 Franchi F, Falciani E, Donadello K, et al. Echocardiography and pulse contour analysis to assess cardiac output in trauma patients. Minerva Anestesiol. 2013;79:137-46.
19 Franchi F, Silvestri R, Cubattoli L, et al. Comparison between an uncalibrated pulse contour method and thermodilution technique for cardiac output estimation in septic patients. Br J Anaesth. 2011;107:202-8.
20 Balderi T, Forfori F, Marra V, et al. Continuous hemodynamic monitoring during laparoscopic gastric bypass in superobese patients by pressure recording analytical method. Obes Surg. 2008;18:1007-14.
21 Nguyen NT, Ho HS, Fleming NW, et al. Cardiac function during laparoscopic vs open gastric bypass. Surg Endosc. 2002;16:78-83.
22 Scolletta S, Bodson L, Donadello K, et al. Assessment of left ventricular function by pulse wave analysis in critically ill patients. Intensive Care Med. 2013;39:1025-33.
23 Sangkum L, Liu GL, Yu L, et al. Minimally invasive or non-invasive cardiac output measurement: an update. J Anesth. 2016;30:461-80.
24 Pinsky MR. Cardiopulmonary interactions: Physiologic basis and clinical applications. Ann Am Thorac Soc. 2018;15:45-8.
Submitted date:
12/09/2019
Accepted date:
04/25/2021
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