Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Case Report

Noninvasive intracranial pressure real-time waveform analysis monitor during prostatectomy robotic surgery and Trendelenburg position: case report

Gabriela Tognini Saba, Vinicius Caldeira Quintão, Suely Pereira Zeferino, Claudia Marquez Simões, Rafael Ferreira Coelho, Arnaldo Fazoli, William Nahas, Gustavo Henrique Frigieri Vilela, Maria José Carvalho Carmona

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Both robotic surgery and head-down tilt increase intracranial pressure by impairing venous blood outflow. Prostatectomy is commonly performed in elderly patients, who are more likely to develop postoperative cognitive disorders. Therefore, increased intracranial pressure could play an essential role in cognitive decline after surgery. We describe a case of a 69-year-old male who underwent a robotic prostatectomy. Noninvasive Brain4careTM intraoperative monitoring showed normal intracranial compliance during anesthesia induction, but it rapidly decreased after head-down tilt despite normal vital signs, low lung pressure, and adequate anesthesia depth. We conclude that there is a need for intraoperative intracranial compliance monitoring since there are major changes in cerebral compliance during surgery, which could potentially allow early identification and treatment of impaired cerebral complacency.


Head-down tilt;  Intracranial pressure;  Robotic surgical procedures


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