Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel.
Department of Gynecologic Oncology, Tel Aviv Sourasky Medical Center (Drs. Laskov, Alpern, Segal, Zindel, Michaan, Grisaru and Ms. Zoborovsky); Department of Anesthesiology, Sackler Faculty of Medicine, Tel Aviv University (Dr. Ronel), Tel Aviv, Israel.
J Minim Invasive Gynecol. 2021 May;28(5):1079-1085. doi: 10.1016/j.jmig.2020.10.005. Epub 2020 Oct 14.
To assess the effect of carbon dioxide (CO) pneumoperitoneum and steep Trendelenburg position on patients' cardiac function and hemodynamics during minimally invasive staging surgery for endometrial cancer.
Single-center prospective longitudinal study.
University-affiliated tertiary hospital.
Patients with endometrial cancer undergoing minimally invasive surgery.
After consent, the patients' hemodynamic parameters were assessed by the Non-Invasive Cardiac System (NI Medical, Petah Tikva, Israel) at 5 time points: before general anesthesia, after induction of general anesthesia, after CO insufflation of the peritoneum, after steep Trendelenburg position, and at the end of surgery.
Twenty-three women were recruited. The median age of the patients was 68 years (interquartile range [IQR] 62-75), with a median body mass index of 34.9 kg/m (IQR 31.2-39.5) and an American Society of Anesthesiologists score ≥2. The initial median mean arterial pressure was 108 mmHg (IQR 101-113), and the baseline median cardiac output was 7.2 L/min (IQR 5.6-8.7). The median mean arterial pressure significantly decreased by 18% after insufflation (p = .001), again after Trendelenburg position (p = .003), and did not fully recover at the end of surgery in comparison with the preanesthesia baseline (p = .001). The median stroke volume significantly decreased by 17% after insufflation compared with the baseline (p = .01) and then gradually recovered to the baseline levels by the end of surgery. The median cardiac power significantly decreased by 35% after insufflation (0.009), remained low during Trendelenburg position (p = .009), and recovered by the end of surgery to 18% below the baseline levels (p = .035).
Significant hemodynamic changes occur during minimally invasive staging surgery for endometrial cancer. CO insufflation is accompanied by the most dramatic hemodynamic deterioration during surgery, and this does not get affected much with Trendelenburg. Knowledge of the hemodynamic values of women classified as high risk when using a noninvasive technique during surgery is obtainable and may assist both surgeon and anesthesiologist to ensure a safer procedure.
评估二氧化碳（CO）气腹和头高脚低位对子宫内膜癌微创分期手术患者心功能和血液动力学的影响。
单中心前瞻性纵向研究。
大学附属三级医院。
接受微创手术的子宫内膜癌患者。
在征得同意后，使用非侵入性心脏系统（NI Medical，Petah Tikva，以色列）在 5 个时间点评估患者的血液动力学参数：全麻前、全麻诱导后、气腹后、头高脚低位后和手术结束时。
共招募了 23 名女性。患者的中位年龄为 68 岁（四分位距 [IQR] 62-75），中位体重指数为 34.9 kg/m（IQR 31.2-39.5），美国麻醉师协会评分≥2 分。初始平均动脉压中位数为 108 mmHg（IQR 101-113），基线中位数心输出量为 7.2 L/min（IQR 5.6-8.7）。气腹后平均动脉压中位数显著下降 18%（p=0.001），头高脚低位后再次下降（p=0.003），与麻醉前基线相比，手术结束时未完全恢复（p=0.001）。与基线相比，气腹后中位每搏量中位数显著下降 17%（p=0.01），然后逐渐恢复到手术结束时的基线水平。气腹后中位心输出量显著下降 35%（0.009），头高脚低位时仍较低（p=0.009），手术结束时恢复至基线水平以下 18%（p=0.035）。
子宫内膜癌微创分期手术过程中会发生明显的血液动力学变化。CO 气腹在手术中伴随着最剧烈的血液动力学恶化，而 Trendelenburg 体位对其影响不大。使用非侵入性技术时，对被归类为高危的女性进行血液动力学值的了解是可行的，这可能有助于外科医生和麻醉师确保手术更安全。
