Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Physiol Funct Imaging. 2022 Mar;42(2):139-145. doi: 10.1111/cpf.12742. Epub 2022 Jan 21.
Robotic prostatectomy requires pneumoperitoneum and a steep Trendelenburg position; however, this condition may compromise cerebral blood flow. Here, we evaluated the effect of pneumoperitoneum and the steep Trendelenburg position on internal carotid artery (ICA) blood flow measured by Doppler ultrasound during robotic prostatectomy.
Patients who underwent robotic prostatectomy were prospectively recruited. The ICA blood flow was measured at the following five time-points: with the patient awake and in the supine position (Ta), 10 min after anaesthetic induction in the supine position (T1), 10 (T2) and 30 (T3) min after pneumoperitoneum in the steep Trendelenburg position, and at the end of surgery in the supine position after desufflation of the pneumoperitoneum (T4). Hemodynamic and cerebrovascular variables were measured at each time-point.
A total of 28 patients were evaluated. The ICA blood flows were significantly lower at T2 and T3 than at T1 (162.3 ± 44.7 [T2] vs. 188.0 ± 49.6 ml/min [T1]; p = .002, 163.1 ± 39.9 [T3] vs. 188.0 ± 49.6 ml/min [T1]; p = .009). The ICA blood flow also differed significantly between Ta and T1 (236.8 ± 58.3 vs. 188.0 ± 49.6 ml/min; p < .001). Heart rates, cardiac indexes, peak systolic velocity, and end-diastolic velocity were significantly lower at T2 and T3 than at T1. However, ICA diameter, mean blood pressure, and end-tidal carbon dioxide partial pressure did not differ significantly at all time-points.
Pneumoperitoneum and the steep Trendelenburg position caused decreased ICA blood flow, suggesting that they should be carefully performed during robotic prostatectomy, especially in patients at risk of postoperative cerebrovascular accident.
机器人前列腺切除术需要气腹和头高脚低位；然而，这种情况可能会影响大脑血流。在这里，我们评估了气腹和头高脚低位对机器人前列腺切除术中经多普勒超声测量的颈内动脉（ICA）血流的影响。
前瞻性招募接受机器人前列腺切除术的患者。在以下五个时间点测量 ICA 血流：患者清醒并仰卧位（Ta），麻醉诱导后仰卧位 10 分钟（T1），气腹后头高脚低位 10（T2）和 30 分钟（T3），以及气腹放气后仰卧位手术结束时（T4）。在每个时间点测量血流动力学和脑血管变量。
共评估了 28 例患者。T2 和 T3 时 ICA 血流明显低于 T1（162.3±44.7[T2]vs.188.0±49.6ml/min[T1]；p=0.002，163.1±39.9[T3]vs.188.0±49.6ml/min[T1]；p=0.009）。Ta 与 T1 之间 ICA 血流也有显著差异（236.8±58.3vs.188.0±49.6ml/min；p<0.001）。T2 和 T3 时心率、心指数、收缩期峰值速度和舒张末期速度明显低于 T1。然而，ICA 直径、平均血压和呼气末二氧化碳分压在所有时间点均无显著差异。
气腹和头高脚低位导致 ICA 血流减少，提示在机器人前列腺切除术中应谨慎操作，尤其是在术后脑血管意外风险较高的患者中。
