Abstract
Robot assisted pelvic surgeries are associated with cardiorespiratory changes due to conjunction of carboperitoneum and steep Trendelenburg position for prolonged durations. To determine the changes in cardiovascular and respiratory systems in patients undergoing elective robot assisted pelvic surgeries under general anesthesia. A prospective observational study was conducted in 35 patients scheduled for elective robot assisted pelvic surgeries. Patients belonging to ASA class I and II were included and their intraoperative hemodynamic and respiratory parameters were noted post induction (baseline), at pneumoperitoneum, at and every 15 minutes after steep Trendelenburg positioning, at resuming supine position, at deflation of pneumoperitoneum and post-deflation. Primary outcome was mean arterial pressure. Secondary outcomes were systolic and diastolic blood pressures, heart rate, central venous pressure, airway pressures (peak, plateau and mean), pulmonary compliance, minute ventilation, end tidal carbondioxide levels and blood gas values. On assuming steep Trendelenburg position, there was significant increase in systolic, mean and diastolic blood pressures. There was significant increase in peak, plateau and mean airway pressures and significant decrease in pulmonary compliance which led to increase in end tidal carbondioxide levels and minute ventilation. On resuming supine position and deflation of pneumoperitoneum, there was significant decrease in mean arterial pressure. Although the pulmonary compliance improved, it continued to be significantly lower than the post-induction baseline value. Robot-assisted pelvic surgeries are associated with significant changes in hemodynamic and respiratory parameters of patients.
Highlights
Robot assisted pelvic surgeries are associated with cardiorespiratory changes due to conjunction of carboperitoneum and steep Trendelenburg position for prolonged durations
Several studies have been conducted in other laparoscopic surgeries involving Trendelenburg position (TP) with head tilt of 15-30◦, but there are few studies conducted on steep TP with pneumoperitoneum. 5–14 we did this prospective observational study in adult patients who were scheduled for elective robotic pelvic surgeries to determine the change in cardiorespiratory function parameters during pneumoperitoneum and steep TP
The introduction of robotic procedures necessitates use of steep Trendelenburg position (TP) in conjunction with pneumoperitoneum leading to changes in cardiorespiratory homeostasis
Summary
Robot assisted pelvic surgeries are associated with cardiorespiratory changes due to conjunction of carboperitoneum and steep Trendelenburg position for prolonged durations. Secondary outcomes were systolic and diastolic blood pressures, heart rate, central venous pressure, airway pressures (peak, plateau and mean), pulmonary compliance, minute ventilation, end tidal carbondioxide levels and blood gas values. There was significant increase in peak, plateau and mean airway pressures and significant decrease in pulmonary compliance which led to increase in end tidal carbondioxide levels and minute ventilation. Conclusion: Robot-assisted pelvic surgeries are associated with significant changes in hemodynamic and respiratory parameters of patients. 5–14 we did this prospective observational study in adult patients who were scheduled for elective robotic pelvic surgeries to determine the change in cardiorespiratory function parameters during pneumoperitoneum and steep TP. Several studies have been conducted in other laparoscopic surgeries involving TP with head tilt of 15-30◦, but there are few studies conducted on steep TP with pneumoperitoneum. 5–14 we did this prospective observational study in adult patients who were scheduled for elective robotic pelvic surgeries to determine the change in cardiorespiratory function parameters during pneumoperitoneum and steep TP.
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