D'Alonzo Richard C, Gan Tong J, Moul Judd W, Albala David M, Polascik Thomas J, Robertson Cary N, Sun Leon, Dahm Philipp, Habib Ashraf S
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
J Clin Anesth. 2009 Aug;21(5):322-8. doi: 10.1016/j.jclinane.2008.09.005. Epub 2009 Aug 22.
To compare anesthetic management and postoperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) and radical retropubic prostatectomy (RRP) with general anesthesia.
Retrospective database study of RALP and RRP patients at Duke University Medical Center from 6/2003 to 6/2006.
University teaching hospital.
541 ASA physical status I, II, and III men, 280 of whom were RRP patients and 256 RALP patients.
Patient demographics, intraoperative fluids and blood products, hemodynamic parameters, pain scores in the Postanesthesia Care Unit (PACU), intraoperative and postoperative analgesic consumption, need for rescue antiemetics in the PACU, and intraoperative use of vasopressors and antihypertensives, were all recorded. Additional data included postoperative transfusion data; clinical status of the patient's cancer preoperatively and postoperatively; hematocrit, platelet count, and creatinine levels; and length of hospital stay.
Estimated blood loss (EBL) was higher for RRP than RALP patients (mean +/- SD; 1,087 +/- 853 mL vs. 287 +/- 317 mL; P < 0.0001). Likewise, 24% of RRP patients received red blood cell (RBC) transfusions intraoperatively, compared with 0.4% RALP patients (P < 0.0001). Intraoperatively, RALP patients received more antihypertensive agents (37% vs. 21%; P < 0.0001), and fewer vasopressors (63% vs. 78%; P < 0.0001) than did RRP patients. The two groups had similar morphine-equivalent opioid use intraoperatively, but in the PACU, RALP patients required fewer morphine equivalents (mean +/- SD; 11.4 +/- 7.7 mg vs. 14.9 +/- 9.8 mg; P < 0.0001). The RALP patients had longer surgical times (mean +/- SD; 296 +/- 76 vs.193 +/- 69 min; P < 0.0001) but shorter PACU stays (mean +/- SD; 113 +/- 55 min vs. 143 +/- 58 min; P < 0.0001) and shorter hospital stays (mean +/- SD; 44 +/- 77 hrs vs. 56 +/- 26 hrs; P = 0.009).
Duration of surgery was greater with RALP, but it was associated with less EBL, fewer transfusions of blood products, and shorter PACU and hospital stays.
比较接受全身麻醉的机器人辅助腹腔镜根治性前列腺切除术（RALP）和耻骨后根治性前列腺切除术（RRP）患者的麻醉管理及术后结果。
对2003年6月至2006年6月在杜克大学医学中心接受RALP和RRP手术的患者进行回顾性数据库研究。
大学教学医院。
541例美国麻醉医师协会（ASA）身体状况为I、II和III级的男性患者，其中280例为RRP患者，256例为RALP患者。
记录患者人口统计学资料、术中液体和血液制品使用情况、血流动力学参数、麻醉后恢复室（PACU）疼痛评分、术中和术后镇痛药物用量、PACU中使用抢救性止吐药的情况以及术中血管升压药和降压药的使用情况。其他数据包括术后输血数据；患者术前和术后癌症的临床状况；血细胞比容、血小板计数和肌酐水平；以及住院时间。
RRP患者的估计失血量（EBL）高于RALP患者（均值±标准差；1087±853ml对287±317ml；P<0.0001）。同样，24%的RRP患者术中接受了红细胞（RBC）输血，而RALP患者为0.4%（P<0.0001）。术中，RALP患者比RRP患者使用更多的降压药（37%对21%；P<0.0001），使用血管升压药的比例更低（63%对78%；P<0.0001）。两组术中使用的吗啡等效阿片类药物相似，但在PACU中，RALP患者需要的吗啡等效剂量更少（均值±标准差；11.4±7.7mg对14.9±9.8mg；P<0.0001）。RALP患者手术时间更长（均值±标准差；296±76对193±69分钟；P<0.0001），但PACU停留时间更短（均值±标准差；113±55分钟对143±58分钟；P<0.0001），住院时间也更短（均值±标准差；44±77小时对56±26小时；P=0.009）。
RALP手术时间更长，但与较少的EBL、较少的血液制品输血以及更短的PACU停留时间和住院时间相关。
