Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy

• Published in: Journal of clinical anesthesia 2014-08, Vol.26 (5), p.383-389
• Main Authors: Rosendal, Christian, MD, Markin, Sergei, Hien, Maximilian D, Motsch, Johann, MD, Roggenbach, Jens, MD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia & Perioperative Care; Anesthesia - methods; Blood pressure; Carbon dioxide; Cardiac output: afterload, preload; Ethics; Head-Down Tilt - physiology; Heart rate; Heart Rate - physiology; Hemodynamics - physiology; Hospitals, University; Humans; Laparoscopy; Laparoscopy - methods; Male; Middle Aged; Pain Medicine; Pneumoperitoneum, Artificial - methods; Prospective Studies; Prostatectomy - methods; Robot-assisted laparoscopic prostatectomy; Robotics; Robots; Surgery; Thermodilution - methods; Transpulmonary thermodiluation; Variance analysis
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2014.01.014

Abstract Study Objective To determine and interpret the changes in preload, afterload, and cardiac function in the different phases of robot-assisted laparoscopic prostatectomy. Design Prospective, observational monocenter study. Setting Operating room at a university hospital. Patients 31 consecutive, ASA physical status 1, 2, and 3 patients. Interventions Observations were made at 5 distinct time points: baseline after induction of anesthesia, after initiation of capnoperitoneum, immediately after a 45° head-down tilt, 15 minutes after the 45° head-down tilt was established, after the release of the capnoperitoneum, and 5 minutes after the patient was returned to a horizontal position (end). Measurements Transpulmonary thermodilution and pulse contour analysis were used to record hemodynamic changes in preload, afterload, and cardiac function. Main Results While central venous pressure increased threefold from baseline, none of the other preload parameters showed excessive fluid overload or demand. There was no significant change in cardiac contractility over time. Afterload increased significantly during the capnoperitoneum and significantly decreased compared with baseline after the release of abdominal pressure at the end of the procedure. Heart rate and cardiac index increased significantly during robot-assisted laparoscopic prostatectomy. Conclusions Selective arterial vasodilation at the time of capnoperitoneum may normalize afterload and myocardial oxygen demand.