Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study
| Autor: | Ursula Kahl, Marlene Fischer, Haissam Ragab, Markus Graefen, Cornelius Rademacher, Dennis Hoop, Christian Zöllner, Stefanie Beck, Franziska von Breunig, Aurelie Meßner-Schmitt, Alexander Haese |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Supine position medicine.medical_treatment Trendelenburg position Health Informatics Autoregulation Critical Care and Intensive Care Medicine Cerebral autoregulation Head-Down Tilt 03 medical and health sciences 0302 clinical medicine Robotic Surgical Procedures 030202 anesthesiology Medicine Homeostasis Humans Anesthesia Original Research Prostatectomy business.industry Prostate Perioperative Cerebral blood flow Anesthesiology and Pain Medicine Blood pressure Laparoscopy business 030217 neurology & neurosurgery |
| Zdroj: | Journal of Clinical Monitoring and Computing |
| ISSN: | 1573-2614 1387-1307 0001-0014 |
| Popis: | Purpose Surgery in the prolonged extreme Trendelenburg position may lead to elevated intracranial pressure and compromise cerebral hemodynamic regulation. We hypothesized that robot-assisted radical prostatectomy with head-down tilt causes impairment of cerebral autoregulation compared with open retropubic radical prostatectomy in the supine position. Methods Patients scheduled for elective radical prostatectomy were included at a tertiary care prostate cancer clinic. Continuous monitoring of the cerebral autoregulation was performed using the correlation method. Based on measurements of cerebral oxygenation with near-infrared spectroscopy and invasive mean arterial blood pressure (MAP), a moving correlation coefficient was calculated to obtain the cerebral oxygenation index as an indicator of cerebral autoregulation. Cerebral autoregulation was measured continuously from induction until recovery from anesthesia. Results There was no significant difference in cerebral autoregulation between robot-assisted and open retropubic radical prostatectomy during induction (p = 0.089), intraoperatively (p = 0.162), and during recovery from anesthesia (p = 0.620). Age (B = 0.311 [95% CI 0.039; 0.583], p = 0.025) and a higher difference between baseline MAP and intraoperative MAP (B = 0.200 [95% CI 0.073; 0.327], p = 0.002) were associated with impaired cerebral autoregulation, whereas surgical technique was not (B = 3.339 [95% CI 1.275; 7.952], p = 0.155). Conclusion Compared with open radical prostatectomy in the supine position, robot-assisted surgery in the extreme Trendelenburg position with capnoperitoneum did not lead to an impairment of cerebral autoregulation during the perioperative period in our study population. Trial registration number: DRKS00010014, date of registration: 21.03.2016, retrospectively registered. |
| Databáze: | OpenAIRE |
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