Takechi Kenichi, Kitamura Sakiko, Shimizu Ichiro, Yorozuya Toshihiro
Matsuyama Red Cross Hospital, 1 Bunkyochou, Matsuyama City, Ehime, Japan.
Department of Anesthesia and Perioperative Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon City, Ehime, Japan.
BMC Anesthesiol. 2018 Aug 18;18(1):114. doi: 10.1186/s12871-018-0567-8.
Decreased perfusion in the lower extremities is one of the several adverse effects of placing patients in a lithotomy or Trendelenburg position during surgery. This study aimed to evaluate the effects of patient positioning in lower limb perfusion patients undergoing robotic-assisted laparoscopic radical prostatectomy (RARP) using near-infrared spectroscopy (NIRS).
This observation study comprised 30 consenting males with American Society of Anaesthesiologists physical status classes I and II (age range, ≥20 to < 80 years). Regional saturation of oxygen measurements was obtained using an INVOS™ oximeter (Somanetics, Troy, MI, USA). A NIRS sensor was positioned on the surface of the skin at the mid-diaphyseal region of the calf muscles (the gastrocnemius and soleus), over the posterior compartment, in the right lower leg. Regional saturation of oxygen (rSO) was sampled during the following time points: before and 5 min after induction of anaesthesia (T0,T1); 5 min after establishment of pneumoperitoneum in a 0° lithotomy position (T2); 5 min after a 25° Trendelenburg position (T3); 30, 60, 90 and 120 min after pneumoperitoneum in a Trendelenburg position (T4, T5, T6 and T7, respectively); after desufflation in a supine position (T8); and after tracheal extubation (T9).
Lower limb perfusion evaluated by NIRS was increased after induction of anaesthesia and maintained during steep Trendelenburg positions in RARP patients with no risk for lower limb compartment syndrome (LLCS) (T0:65 ± 7.2%, T1:69 ± 6.1%, T2:70±:6.1%, T3:68 ± 6.7%, T4:66 ± 7.5%, T5:67 ± 6.9%, T6:68 ± 7.2%, T8:73 ± 7.2%, T9:71 ± 7.9%, respectively).
Lower limb perfusion evaluated by NIRS was maintained during the RARP procedure. Correct patient positioning and careful assessment of risk factors such as vascular morbidity could be important for the prevention of LLCS during RARP.
在手术过程中将患者置于截石位或头低脚高位会产生多种不良影响，其中下肢灌注减少是其中之一。本研究旨在使用近红外光谱（NIRS）评估机器人辅助腹腔镜根治性前列腺切除术（RARP）患者体位对下肢灌注的影响。
本观察性研究纳入了30名自愿参与的美国麻醉医师协会身体状况分级为I级和II级的男性患者（年龄范围为≥20至<80岁）。使用INVOS™血氧饱和度仪（美国密歇根州特洛伊市的Somanetics公司）测量局部氧饱和度。将NIRS传感器置于右小腿后侧肌间隔中腓肠肌和比目鱼肌骨干中部区域的皮肤表面。在以下时间点采集局部氧饱和度（rSO）：麻醉诱导前和诱导后5分钟（T0、T1）；0°截石位建立气腹后5分钟（T2）；25°头低脚高位后5分钟（T3）；头低脚高位气腹后30、60、90和120分钟（分别为T4、T5、T6和T7）；仰卧位放气后（T8）；气管拔管后（T9）。
在无下肢筋膜室综合征（LLCS）风险的RARP患者中，麻醉诱导后通过NIRS评估的下肢灌注增加，并在深度头低脚高位期间保持（T0：65±7.2%，T1：69±6.1%，T2：70±6.1%，T3：68±6.7%，T4：66±7.5%，T5：67±6.9%，T6：68±7.2%，T8：73±7.2%，T9：71±7.9%）。
在RARP手术过程中，通过NIRS评估的下肢灌注得以维持。正确的患者体位摆放以及对血管病变等危险因素的仔细评估对于预防RARP期间的LLCS可能很重要。
