Lahaye Laura, Grasso Mario, Green Jeffrey, Biddle C J
Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA.
J Robot Surg. 2015 Mar;9(1):19-25. doi: 10.1007/s11701-014-0483-y. Epub 2014 Aug 21.
Demands associated with the Trendelenburg position (TP) are well known yet there is little attention given to regional cerebral tissue O2 saturation (SctO2) in those undergoing robotic surgery in the TP with CO2 insufflation (C-INSF). This is the first study to report on SctO2 in a wide range of patients undergoing lengthy TP and robotic surgery. We measured SctO2 during robotic surgery in patients in the TP with C-INSF, as well as a control robotic thyroid surgery group who were supine with no C-INSF. We recorded relevant variables and periods of cerebral desaturation (CD). We studied 42 patients in 25°-45° of TP for ≥125 min. Management was at the providers' discretion. The INVOS(®) 5100C Cerebral Oximeter (Covidien, Boulder, CO) recorded SctO2. CD was defined as a >20 % decrease from baseline SctO2 or a value ≤55 % for ≥10 min. Patients were assessed for adverse outcome. The sample consisted of 13 males and 29 females aged 22-73, BMI 22-36 had general (N = 3), urological (N = 14) and gynecological (N = 25) surgery; two patients had CD lasting 150 and 190 min and two had episodic CD lasting 10-35 min. The four were female aged 22-60 in 38°-45° of TP. Eleven cases had multiple episodic CD for ≤15 min, 27 TP cases had no CD. Other observations included a consistent fall in SctO2 with phenylephrine; an increased SctO2 with ephedrine; and FiO2 and EtCO2 being generally strong, direct modifiers of SctO2. High MAP was inconsistently associated with high SctO2. BMI had no observed effect on SctO2. Pulse oximetry was ≥97 % in all cases. We observed no adverse cerebral events on follow-up. Additional clinical studies are warranted.
与特伦德伦伯格体位（TP）相关的要求是众所周知的，但在接受二氧化碳气腹（C-INSF）的TP机器人手术患者中，很少有人关注局部脑组织氧饱和度（SctO2）。这是第一项报告在广泛的接受长时间TP和机器人手术患者中SctO2情况的研究。我们测量了接受C-INSF的TP患者在机器人手术期间的SctO2，以及仰卧位且无C-INSF的对照机器人甲状腺手术组患者的SctO2。我们记录了相关变量和脑氧饱和度降低（CD）的时间段。我们研究了42例处于25°-45°TP体位≥125分钟的患者。管理由医护人员自行决定。INVOS（®）5100C脑血氧饱和度仪（Covidien，博尔德，科罗拉多州）记录SctO2。CD被定义为SctO2较基线下降>20%或值≤55%持续≥10分钟。对患者进行不良结局评估。样本包括13名男性和29名女性，年龄22-73岁，BMI 22-36，接受普通外科手术（N = 3）、泌尿外科手术（N = 14）和妇科手术（N = 25）；两名患者的CD持续150和190分钟，两名患者有间歇性CD持续10-35分钟。这四名患者为22-60岁的女性，处于38°-45°TP体位。11例有多次间歇性CD持续≤15分钟，27例TP患者无CD。其他观察结果包括去氧肾上腺素使SctO2持续下降；麻黄碱使SctO2升高；FiO2和EtCO2通常是SctO2的强效直接调节因素。高平均动脉压（MAP）与高SctO2的相关性不一致。BMI对SctO2无观察到的影响。所有病例的脉搏血氧饱和度均≥97%。我们随访未观察到不良脑事件。有必要进行更多的临床研究。
