Prediction of hypotension after postural change in robot-assisted laparoscopic prostatectomy using esophageal Doppler monitoring: a prospective observational trial

Na Young Kim,Hye Jung Shin,Ki Jun Kim,Ji Young Min,Tae Lim Kim,Min Huiy Lee,Chaerim Oh,So Yeon Kim

doi:10.1038/s41598-021-93990-3

Na Young Kim, Hye Jung Shin + Show 6 more

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Journal: Scientific Reports	Publication Date: Jul 16, 2021
Citations: 2	License type: open-access

Affiliation: Yonsei University, Catholic University of Korea

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Postural change from a steep Trendelenburg position to a supine position (T-off) during robot-assisted laparoscopic prostatectomy (RALP) induces a considerable abrupt decrease in the mean arterial pressure (MAP). We investigated the variables for predicting postural hypotension induced by T-off using esophageal Doppler monitoring (EDM). One hundred and twenty-five patients undergoing RALP were enrolled. Data on the MAP, heart rate, stroke volume index (SVI), cardiac index, peak velocity, corrected flow time, stroke volume variation, pulse pressure variation, arterial elastance (Ea), and dynamic arterial elastance were collected before T-off and at 1, 3, 5, 7, and 10 min after T-off using EDM. MAP < 60 mmHg within 10 min after T-off was considered to indicate hypotension, and 25 patients developed hypotension. The areas under the curves of the MAP, SVI, and Ea were 0.734 (95% confidence interval [CI] 0.623–0.846; P < 0.001), 0.712 (95% CI 0.598–0.825; P < 0.001), and 0.760 (95% CI 0.646–0.875; P < 0.001), respectively, with threshold values of ≤ 74 mmHg, ≥ 42.5 mL/m2, and ≤ 1.08 mmHg/mL, respectively. If patients have MAP < 75 mmHg with SVI ≥ 42.5 mL/m2 or Ea ≤ 1.08 mmHg/mL before postural change from T-off during RALP, prompt management for ensuing hypotension should be considered.Trial registration: NCT03882697 (ClinicalTrial.gov, March 20, 2019).

Highlights

Robot-assisted laparoscopic prostatectomy (RALP) has become a more favorable surgical technique than open prostatectomy based on postoperative complications, perioperative outcomes, and functional o utcomes[1,2]
This prospective observational study was the first to investigate the hemodynamic variables for predicting hypotension after T-off during robot-assisted laparoscopic prostatectomy (RALP)
With the use of Esophageal Doppler monitoring (EDM), we found that a high stroke volume index (SVI) and low Ea can be used to predict postural hypotension during RALP

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Introduction

Robot-assisted laparoscopic prostatectomy (RALP) has become a more favorable surgical technique than open prostatectomy based on postoperative complications, perioperative outcomes, and functional o utcomes[1,2]. A specific physiologic condition is required for RALP: pneumoperitoneum with carbon dioxide (CO2) insufflation and a steep Trendelenburg position of ≥ 30°3–5 These combined effects can result in considerable hemodynamic alterations, including > 30% increase in the mean arterial pressure (MAP) and a threefold increase in the central venous pressure (CVP)[3,4]. One study investigated the variables that can predict hypotension after a postural change from the supine to the beach chair position (70° upright position)[6]. This hemodynamic change may differ from that in patients undergoing a postural change from a steep Trendelenburg position to a supine position during RALP. We investigated the variables that could predict postural hypotension induced by changing a patient’s position from a Trendelenburg position to a supine position (T-off) during RALP using EDM

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