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Chiumello D, Fratti I, Coppola S. The intraoperative management of robotic-assisted laparoscopic prostatectomy. Curr Opin Anaesthesiol 2023; 36:657-665. [PMID: 37724574 DOI: 10.1097/aco.0000000000001309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
PURPOSE OF REVIEW Robotic-assisted laparoscopic radical prostatectomy has become the second most commonly performed robotic surgical procedure worldwide, therefore, anesthesiologists should be aware of the intraoperative pathophysiological consequences. The aim of this narrative review is to report the most recent updates regarding the intraoperative management of anesthesia, ventilation, hemodynamics and central nervous system, during robotic-assisted laparoscopic radical prostatectomy. RECENT FINDINGS Surgical innovations and the advent of new technologies make it imperative to optimize the anesthesia management to provide the most holistic approach possible. In addition, an ageing population with an increasing burden of comorbidities requires multifocal attention to reduce the surgical stress. SUMMARY Total intravenous anesthesia (TIVA) and balanced general anesthesia are similar in terms of postoperative complications and hospital stay. Reversal of rocuronium is associated with shorter hospital stay and postanesthesia recovery time. Adequate PEEP levels improve oxygenation and driving pressure, and the use of a single recruitment maneuver after the intubation reduces postoperative pulmonary complications. Restrictive intravenous fluid administration minimizes bladder-urethra anastomosis complications and facial edema. TIVA maintains a better autoregulation compared with balanced general anesthesia. Anesthesiologists should be able to optimize the intraoperative management to improve outcomes.
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Affiliation(s)
- Davide Chiumello
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan
- Department of Health Sciences
- Coordinated Research Center on Respiratory Failure, University of Milan, Italy
| | | | - Silvia Coppola
- Department of Anesthesia and Intensive Care, ASST Santi Paolo e Carlo, San Paolo University Hospital Milan
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2
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Ripa M, Schipa C, Kopsacheilis N, Nomikarios M, Perrotta G, De Rosa C, Aceto P, Sollazzi L, De Rosa P, Motta L. The Impact of Steep Trendelenburg Position on Intraocular Pressure. J Clin Med 2022; 11:jcm11102844. [PMID: 35628970 PMCID: PMC9146028 DOI: 10.3390/jcm11102844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Intraocular pressure occurring during the Trendelenburg position may be a risk for postoperative visual loss and other ocular complications. Intraocular pressure (IOP) higher than 21 mmHg poses a risk for ocular impairment causing several conditions such as glaucoma, detached retina, and postoperative vision loss. Many factors might play a role in IOP increase, like peak expiratory pressure (PIP), mean arterial blood pressure (MAP), end-tidal CO2 (ETCO2) and surgical duration and some others (anaesthetic and neuromuscular blockade depth) contribute by reducing IOP during procedures requiring both pneumoperitoneum and steep Trendelenburg position (25–45° head-down tilt). Despite transient visual field loss after surgery, no signs of ischemia or changes to the retinal nerve fibre layer (RNFL) have been shown after surgery. Over the years, several studies have been conducted to control and prevent IOPs intraoperative increase. Multiple strategies have been proposed by different authors over the years to reduce IOP during laparoscopic procedures, especially those involving steep Trendelenburg positions such as robot-assisted laparoscopic prostatectomy (RALP), and abdominal and pelvic procedures. These strategies included both positional and pharmacological strategies.
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Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
| | - Chiara Schipa
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-3290730977
| | - Nikolaos Kopsacheilis
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK;
- New Hayesbank Ophthalmology Services, Cemetery Lane, Kennington, Ashford TN24 9JZ, UK
| | - Mikes Nomikarios
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.N.); (L.M.)
| | - Gerardo Perrotta
- GI Surgery Department, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Carlo De Rosa
- Department of Ophthalmology, A. Cardarelli Hospital, 80131 Naples, Italy; (C.D.R.); (P.D.R.)
| | - Paola Aceto
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Liliana Sollazzi
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Pasquale De Rosa
- Department of Ophthalmology, A. Cardarelli Hospital, 80131 Naples, Italy; (C.D.R.); (P.D.R.)
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.N.); (L.M.)
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Mitsunaga JK, Calsavara VF, Onari ES, Arantes VM, Akamine CP, Handa AM, Quezada MMDLC, Ito FY, Porto ACS, Giroud Joaquim EH, Nakamura G. Spinal block and delirium in oncologic patients after laparoscopic surgery in the Trendelenburg position: A randomized controlled trial. PLoS One 2021; 16:e0249808. [PMID: 33999920 PMCID: PMC8128254 DOI: 10.1371/journal.pone.0249808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/23/2021] [Indexed: 12/19/2022] Open
Abstract
Delirium is the most common postsurgical neurological complication and has a variable incidence rate. Laparoscopic surgery, when associated with the Trendelenburg position, can cause innumerable physiological changes and increase the risk of neurocognitive changes. The association of general anesthesia with a spinal block allows the use of lower doses of anesthetic agents for anesthesia maintenance and facilitates better control over postoperative pain. Our primary outcome was to assess whether a spinal block influences the incidence of delirium in oncologic patients following laparoscopic surgery in the Trendelenburg position. Our secondary outcome was to analyze whether there were other associated factors. A total of 150 oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position were included in this randomized controlled trial. The patients were randomized into 2 groups: the general anesthesia group and the general anesthesia plus spinal block group. Patients were immediately evaluated during the postoperative period and monitored until they were discharged, to rule out the presence of delirium. Delirium occurred in 29 patients in total (22.3%) (general anesthesia group: 30.8%; general anesthesia plus spinal block: 13.8% p = 0.035). Patients who received general anesthesia had a higher risk of delirium than patients who received general anesthesia associated with a spinal block (odds ratio = 3.4; 95% confidence interval: 1.2–9.6; p = 0.020). Spinal block was associated with reduced delirium incidence in oncologic patients who underwent elective laparoscopic surgeries in the Trendelenburg position.
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Affiliation(s)
| | | | - Elton Shinji Onari
- Department of Anaesthesiology, A.C.Camargo Cancer Center, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Giane Nakamura
- Department of Anaesthesiology, A.C.Camargo Cancer Center, São Paulo, Brazil
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The Effect of Increased Intraocular Pressure During Steep Trendelenburg Positioning in Robotic Prostatectomy and Hysterectomy on Structural and Functional Ocular Parameters. Anesth Analg 2020; 130:975-982. [PMID: 31913912 DOI: 10.1213/ane.0000000000004547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Robotic prostatectomy and robotic hysterectomy require steep Trendelenburg positioning. Many authors documented significant increases in intraocular pressure (IOP) during steep Trendelenburg. However, the long-term biological effect of a significant increase in IOP on the structural and functional ocular system is unknown. This study examines the effect of a significant increase in IOP on the visual acuity, retinal nerve fiber layer thickness (RNFLT), and ganglion cell complex (GCC) thickness in 52 patients without preexisting ocular disease of both genders before and 3 months after their procedures. METHODS This was a prospective cohort study. The total number of patients included was 56, then 3 females and 1 male case were excluded, totaling 28 robotic hysterectomies and 24 robotic prostatectomies were performed. Patients underwent complete eye examination before the procedure and 3 months after, measuring the main outcome of RNFLT and the secondary outcomes of GCC thickness, foveal threshold (FT), mean deviation (MD), and pattern standard deviation (PSD). These outcomes were analyzed using linear mixed-effects models. On the day of surgery, we examined the IOP after induction of anesthesia, at the end of steep Trendelenburg, and in the recovery room. RESULTS There were significant differences in IOP values at the end of steep Trendelenburg versus after induction and 45-60 minutes post-awakening (P < .001 for both groups). No difference between IOP 45 and 60 minutes post-awakening and IOP after induction was observed in either group. The highest IOPs occurred at the end of the steep Trendelenburg time point for both groups. The mean duration of steep Trendelenburg in robotic prostatectomy was 184.6 minutes (standard deviation [SD] = 30.8), while the mean duration in robotic hysterectomy was 123.0 minutes (SD = 29.8). All ophthalmologic examinations were normal preoperatively and 3 months postoperatively. The ocular parameters in the retina and optic disk did not differ significantly before surgery and 3 months after. CONCLUSIONS There is a significant increase in IOP during steep Trendelenburg positioning. There was no significant difference in the ocular parameters examined 3 months after the procedure in this cohort.
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Shirono Y, Takizawa I, Kasahara T, Maruyama R, Yamana K, Tanikawa T, Hara N, Sakaue Y, Togano T, Nishiyama T, Fukuchi T, Tomita Y. Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors. BMC Urol 2020; 20:26. [PMID: 32164666 PMCID: PMC7069168 DOI: 10.1186/s12894-020-00595-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Steep Trendelenburg position (ST) during robot-assisted radical prostatectomy (RARP) poses a risk of increase in intraocular pressure (IOP) in men receiving robot-assisted radical prostatectomy (RARP). The aim of the study was to identify clinicopathological factors associated with increased IOP during RARP. Methods We prospectively studied 59 consecutive prostate cancer patients without glaucoma. IOP was measured at 6 predefined time points before, during and after the operation (T1 to T6). Results Compared with T1, IOP decreased after beginning of anesthesia(T2) (by − 6.5 mmHg, p < 0.05), and increased 1 h after induction of pneumoperitoneum in the steep Trendelenburg position (ST) (T3) (+ 7.3 mmHg, p < 0.05). IOP continued to increase until the end of ST (T4) (+ 10.2 mmHg, p < 0.05), and declined when the patient was returned to supine position under general anesthesia (T5) (T1: 20.0 and T5: 20.1 mmHg, p above 0.05). The console time affected the elevation of IOP in ST; IOP elevation during ST was more prominent in men with a console time of ≥4 h (n = 39) than in those with a console time of < 4 h (n = 19) (19.8 ± 6.3 and 15.4 ± 5.8 mmHg, respectively, p < 0.05). Of the 59 patients, 29 had a high baseline IOP (20.0 mmHg or higher), and their IOP elevated during ST was also reduced at T5 (T1: 22.6 and T5: 21.7 mmHg, p above 0.05). There were no postoperative ocular complications. Conclusions Console time of < 4 h is important to prevent extreme elevation of IOP during RARP. Without long console time, RARP may be safely performed in those with relatively high baseline IOP.
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Affiliation(s)
- Yuko Shirono
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan.
| | - Itsuhiro Takizawa
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Takashi Kasahara
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Ryo Maruyama
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Kazutoshi Yamana
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Toshiki Tanikawa
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Noboru Hara
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Yuta Sakaue
- Division of ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tetsuya Togano
- Division of ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tsutomu Nishiyama
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
| | - Takeo Fukuchi
- Division of ophthalmology and Visual Science, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yoshihiko Tomita
- Division of Urology, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1, Niigata, 951-8510, Japan
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Kakutani S, Asamoto M, Araki F, Chen YN, Shinokawa M, Okagami Y, Ohata T, Taguchi S, Yamada Y, Takeshima Y, Kume H, Yamada Y, Aihara M, Ito N, Fukuhara H. Prospective evaluation of visual function in patients with ocular diseases after robot-assisted laparoscopic prostatectomy. Int J Urol 2020; 27:307-312. [PMID: 32048341 DOI: 10.1111/iju.14183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/19/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate intraocular pressure and visual function in patients with ocular diseases undergoing robot-assisted laparoscopic prostatectomy. METHODS We carried out a prospective clinical study of patients undergoing robot-assisted laparoscopic prostatectomy for localized prostate cancer at The University of Tokyo Hospital from December 2015 to March 2017. An ophthalmologist measured intraocular pressure, and carried out visual field testing at 0-2 months before and 7 days after robot-assisted laparoscopic prostatectomy. During the surgery, an anesthesiologist measured intraocular pressure at specified time points. RESULTS A total of 110 patients were enrolled and 98 eligible patients were analyzed; 37 were diagnosed with ocular diseases before robotic-assisted laparoscopic prostatectomy (17 with glaucoma, 20 with other ocular diseases). Intraocular pressure significantly increased during robot-assisted laparoscopic prostatectomy. Transient postoperative visual field defect was detected in 24 eyes of 17 patients, including six patients with ocular diseases at 7 days after surgery. At 3 months after surgery, one of 34 glaucomatous eyes and one of 40 eyes with non-glaucomatous ocular diseases continued to show visual field defect, although visual field defect in the remaining patients recovered to preoperative conditions within 3 months. CONCLUSIONS Our findings suggest that robot-assisted laparoscopic prostatectomy can be safely carried out in patients with ocular diseases, even those with glaucoma, after precautionary consultation with an ophthalmologist.
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Affiliation(s)
- Shigenori Kakutani
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Masaaki Asamoto
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Fumiyuki Araki
- Department of Ophthalmology and Vision Correction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yi-Ning Chen
- Department of Ophthalmology and Vision Correction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miki Shinokawa
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuko Okagami
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Takuya Ohata
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Satoru Taguchi
- Department of Urology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuta Takeshima
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshitsugu Yamada
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology and Vision Correction, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuko Ito
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Faculty of Medicine, Kyorin University, Tokyo, Japan
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7
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Chen K, Wang L, Wang Q, Liu X, Lu Y, Li Y, Wong GTC. Effects of pneumoperitoneum and steep Trendelenburg position on cerebral hemodynamics during robotic-assisted laparoscopic radical prostatectomy: A randomized controlled study. Medicine (Baltimore) 2019; 98:e15794. [PMID: 31124975 PMCID: PMC6571426 DOI: 10.1097/md.0000000000015794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We evaluated the relationship between ultrasonographical acquired parameters and short-term postoperative cognitive function in patients undergoing robotic-assisted radical prostatectomy (RALP). METHODS Ninety elderly patients scheduled for RALP had their optic nerve sheath diameter (ONSD), the cross-sectional area (CSA) of the internal jugular vein (IJV) and the IJV valve (IJVV) competency assessed by ultrasound. The patients were analyzed in 2 groups based on whether displayed IJVV incompetency (IJVVI). The 3 parameters were measured before anesthesia (T0), immediately after induction of general anesthesia (T1), 5 minutes after establishing pneumoperitoneum (T2), 5 minutes after placing the patient in the Trendelenburg position (T3), and 5 minutes after the release of the pneumoperitoneum in the supine position (T4). Regional cerebral tissue oxygen saturation (rSO2) was also measured by near-infrared spectroscopy intraoperatively. The Mini-Mental State Examination (MMSE) and Confusion Assessment Method (CAM) were performed the day before surgery and on postoperative days 1, 3, and 7. RESULTS We found that 52% of patients had evidence of IJVVI after being placed in the Trendelenburg position after pneumoperitoneum was established (T4). Patient with IJVVI showed a significant increase of ONSD and CSA at T1, T2, T3, T4 but there was no associated decrease in rSO2. MMSE scores were reduced at postoperative day 1 and the 7 patients that developed postoperative delirium came from Group IJVVI. CONCLUSIONS Our observations suggest that elderly patients that show IJVVI after adequate positioning for RALP may develop elevated intracranial pressure as well as mildly compromised postoperative cognitive function in the short term.
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Affiliation(s)
- Ke Chen
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University
| | - Lizhen Wang
- Department of Anesthesiology, First Affiliated Hospital, University of Science and Technology of China, Hefei, Anhui
| | - Qing Wang
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University
| | - Xuesheng Liu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University
| | - Yao Lu
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University
| | - Yuanhai Li
- Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University
| | - Gordon Tin Chun Wong
- Department of Anaesthesiology, The University of Hong Kong, Hong Kong S.A.R., China
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Aceto P, Beretta L, Cariello C, Claroni C, Esposito C, Forastiere EM, Guarracino F, Perucca R, Romagnoli S, Sollazzi L, Cela V, Ercoli A, Scambia G, Vizza E, Ludovico GM, Sacco E, Vespasiani G, Scudeller L, Corcione A. Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU. Minerva Anestesiol 2019; 85:871-885. [PMID: 30938121 DOI: 10.23736/s0375-9393.19.13360-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Proper management of patients undergoing robotic-assisted urologic and gynecologic surgery must consider a series of peculiarities in the procedures for anesthesiology, critical care medicine, respiratory care, and pain management. Although the indications for robotic-assisted urogynecologic surgeries have increased in recent years, specific guidance documents are still lacking. EVIDENCE ACQUISITION A multidisciplinary group including anesthesiologists, gynecologists, urologists, and a clinical epidemiologist systematically reviewed the relevant literature and provided a set of recommendations and unmet needs on peculiar aspects of anesthesia in this field. EVIDENCE SYNTHESIS Nine core contents were identified, according to their requirements in urogynecologic robotic-assisted surgery: patient position, pneumoperitoneum and ventilation strategies, hemodynamic variations and fluid therapy, neuromuscular block, renal surgery and prevention of acute kidney injury, monitoring the Department of anesthesia, postoperative delirium and cognitive dysfunction, prevention of postoperative nausea and vomiting, and pain management in endometriosis. CONCLUSIONS This consensus document provides guidance for the management of urologic and gynecologic patients scheduled for robotic-assisted surgery. Moreover, the identified unmet needs highlight the requirement for further prospective randomized studies.
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Affiliation(s)
- Paola Aceto
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Luigi Beretta
- Unit of Anesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Cariello
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Claudia Claroni
- Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Clelia Esposito
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
| | - Ester M Forastiere
- Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Guarracino
- Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Raffaella Perucca
- Department of Anesthesia and Intensive Care, Maggiore della Carità Hospital, Novara, Italy
| | - Stefano Romagnoli
- Section of Anesthesia and Critical Care, Health Science Department, University of Florence, Florence, Italy.,Department of Anesthesia and Critical Care, Careggi Hospital, Florence, Italy
| | - Liliana Sollazzi
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Vito Cela
- Department of Clinical and Experimental Medicine, Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy
| | - Alfredo Ercoli
- Department of Obstetrics and Gynecology, Amedeo Avogadro University of Eastern Piedmont, Maggiore Hospital, Novara, Italy
| | - Giovanni Scambia
- A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy.,Sacred Heart Catholic University, Rome, Italy
| | - Enrico Vizza
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe M Ludovico
- Department of Urology, F. Miulli Regional Hospital, Acquavivadelle Fonti, Bari, Italy
| | - Emilio Sacco
- Department of Urology, Sacred Heart Catholic University, A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy
| | - Giuseppe Vespasiani
- Department of Experimental Medicine and Surgery, University Hospital of Tor Vergata, Rome, Italy
| | - Luigia Scudeller
- Unit of Clinical Epidemiology, San Matteo IRCSS Foundation, Pavia, Italy -
| | - Antonio Corcione
- Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy
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9
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Balbay MD, Koc E, Canda AE. Robot-assisted radical cystectomy: patient selection and special considerations. ROBOTIC SURGERY (AUCKLAND) 2017; 4:101-106. [PMID: 30697568 PMCID: PMC6193425 DOI: 10.2147/rsrr.s119858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Robot-assisted (RA) procedures are increasingly being performed as minimally invasive surgical approaches. Less insensible losses due to a closed abdomen, smaller incisions with less retractor strain, decreased analgesic requirements, and earlier postoperative ambulation are suggested advantages of robot-assisted radical cystectomy (RARC). Patients who undergo open radical cystectomy are also candidates for RARC procedure. However, the steep Trendelenburg position and pneumoperitoneum develop a non-physiological condition. Intra-abdominal adhesions preventing the placement of the ports and patients who cannot tolerate the pneumoperitoneum and/or steep Trendelenburg position are special contraindications of RARC. Besides, body mass index >30 kg/m2, presence of extravesical disease, bulky lymphadenopathy, previous vascular surgery, previous distal colorectal surgery, previous pelvic radiation, previous pelvic trauma, and/or preexisting cardiovascular/pulmonary disease that is compromised with positioning are not certainly contraindicated but unwanted conditions in which the RARC may be performed successfully as the surgeons gain experience.
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Affiliation(s)
| | - Erdem Koc
- Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Department of Urology, School of Medicine, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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10
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Katsanos A, Dastiridou AI, Quaranta L, Rulli E, Riva I, Dimasi V, Tsironi EE, Weinreb RN. The Effect of Posture on Intraocular Pressure and Systemic Hemodynamic Parameters in Treated and Untreated Patients with Primary Open-Angle Glaucoma. J Ocul Pharmacol Ther 2017; 33:598-603. [PMID: 28813622 DOI: 10.1089/jop.2017.0030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess intraocular pressure (IOP), systolic, diastolic, and mean arterial blood pressure (SBP, DBP, MAP) changes in the sitting, supine, and 20° head-down (Trendelenburg) position in treated (tPOAG) and untreated (uPOAG) primary open-angle glaucoma patients and healthy controls. METHODS All participants underwent IOP and systemic BP measurements in the sitting, supine, and Trendelenburg positions during office hours. IOP and BP readings in the sitting, supine, and Trendelenburg positions were analyzed. RESULTS Twenty-one tPOAG patients, 17 uPOAG patients, and 21 controls were enrolled in the study. Compared to controls, eyes in the tPOAG and uPOAG groups had significantly larger posture-induced IOP elevation upon changing from the sitting to the supine position (P = 0.020 and P = 0.032, respectively). Compared to controls, the IOP elevation in the Trendelenburg position was statistically higher for the tPOAG (P = 0.003), but not the uPOAG group (P = 0.840). All 3 groups had a similar pattern of SBP, DBP, and MAP changes. CONCLUSIONS Compared to controls, posture-induced IOP changes are more pronounced in treated and untreated POAG patients.
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Affiliation(s)
- Andreas Katsanos
- 1 Department of Ophthalmology, University of Ioannina , Ioannina, Greece
| | | | - Luciano Quaranta
- 3 Section of Ophthalmology, Department of Medical and Surgical Specialties, University of Brescia , Brescia, Italy
| | - Eliana Rulli
- 4 IRCCS-Istituto di Ricerche Farmacologiche Mario Negri , Milan, Italy
| | - Ivano Riva
- 3 Section of Ophthalmology, Department of Medical and Surgical Specialties, University of Brescia , Brescia, Italy
| | - Varvara Dimasi
- 2 Ophthalmology Clinic, University of Thessaly , Larissa, Greece
| | - Evangelia E Tsironi
- 5 Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Thessaly , Larissa, Greece
| | - Robert N Weinreb
- 6 Hamilton Glaucoma Center, Shiley Eye Institute, University of California , San Diego, San Diego, California.,7 Department of Ophthalmology, University of California , San Diego, San Diego, California
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