Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy
Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy
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DOI：
10.1093/bja/aeq018
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发表时间：
2010-04-01
影响因子：
9.8
通讯作者：
Struys, M. M. R. F.
中科院分区：
文献类型：
--
作者：
Kalmar, A. F.;Foubert, L.;Struys, M. M. R. F.
陡峭（40度）的头低脚高位可优化机器人直肠切除术期间的手术暴露。本研究的目的是调查这种位置和CO2气腹对心血管，脑血管和呼吸稳态的综合影响，在这些provisions.Physiological数据记录在整个手术过程中的31例连续患者接受机器人内窥镜根治性直肠癌切除术全麻下。监测并记录心率、平均动脉压、中心静脉压、Sp（o2）、Pe '（co2）、P-Plat、潮气量、顺应性和每分钟通气量。获取动脉样本以确定动脉至潮气末CO2张力梯度。通过近红外光谱法测定连续局部脑组织氧饱和度（Sct（o2）），尽管患者处于头低脚高位，但所有研究变量均在临床可接受范围内。脑灌注压（CPP）从基线时的77 mm Hg降至71 mm Hg（P=0.07），Sct（o2）从70%增至73%（P < 0.001）。Pe '（co2）从4.12 kPa增加到4.79 kPa（P < 0.001），动脉与Pe'（co2）张力差从正常体位的1.06 kPa增加到头高脚低体位2小时后的最大值1.41 kPa（P < 0.001）。长期陡峭头高脚低体位和CO2气腹的组合耐受性良好。血液动力学和肺部变量保持在安全范围内。局部脑氧合保持良好，CPP保持在脑血流量通常被认为是由脑自动调节维持的限度内。
The steep (40 degrees) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to investigate the combined effect of this position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during these procedures.Physiological data were recorded during the whole surgical procedure in 31 consecutive patients who underwent robotic endoscopic radical prostatectomy under general anaesthesia. Heart rate, mean arterial pressure, central venous pressure, Sp(o2), Pe'(co2), P-Plat, tidal volume, compliance, and minute ventilation were monitored and recorded. Arterial samples were obtained to determine the arterial-to-end-tidal CO2 tension gradient. Continuous regional cerebral tissue oxygen saturation (Sct(o2)) was determined by near-infrared spectroscopy.Although patients were in the Trendelenburg position, all variables investigated remained within a clinically acceptable range. Cerebral perfusion pressure (CPP) decreased from 77 mm Hg at baseline to 71 mm Hg (P=0.07), and Sct(o2) increased from 70% to 73% (P < 0.001). Pe'(co2) increased from 4.12 to 4.79 kPa (P < 0.001) and the arterial-to-Pe'(co2) tension difference increased from 1.06 kPa in the normal position to a maximum of 1.41 kPa (P < 0.001) after 2 h in the Trendelenburg position.The combination of the prolonged steep Trendelenburg position and CO2 pneumoperitoneum was well tolerated. Haemodynamic and pulmonary variables remained within safe limits. Regional cerebral oxygenation was well preserved and CPP remained within the limits between which cerebral blood flow is usually considered to be maintained by cerebral autoregulation.