Original Article
A clinical study of lung function protection in patients with robot assisted laparoscopic radical prostatectomy
Wang Ting, Chen Ke, Wang Yiqiao, Lu Xianfu, Li Yuanhai
Published 2018-11-15
Cite as Int J Anesth Resus, 2018,39(11): 1010-1015. DOI: 10.3760/cma.j.issn.1673-4378.2018.11.003
Abstract
ObjectiveTo evaluate the effect of manipulative pulmonary protective strategy on the pulmonary function of the patients undergoing robotic assisted laparoscopic radical prostatectomy under multiple-mode monitoring.
MethodsOne hundred and twenty patients who underwent robot-assisted laparoscopic radical prostatectomy were divided into 4 groups (30 cases in each group) according to ASA Ⅰ-Ⅲ. Multimodal monitoring + manual relaxation group (group Mm), multimodal monitoring group (group M), conventional anesthesia + manual relaxation group (group m) and conventional anesthesia group (group C). In group Mm and group M, propofol was infused to achieve the BIS value of 45-55, then we monitored the muscle relaxation to conduct closed-loop infusion of cisatracurium. We also monitored and managed liquid input by vigileo. Group M and group C maintained peak airway pressure (≤30 cmH2O) (1 cmH2O=0.098 kPa) and PETCO2 35-40 mmHg (1 mmHg=0.133 kPa). Group Mm and group m received manual lung recruitment maneuver one times every 30 min after establishment of pneumoperitoneum until the end of operation. Blood gas analysis was performed before anesthesia induction (T1), 15 min after intubation (T2), 10 min after pneumoperitoneum (T3), 30 min after pneumoperitoneum (T4), 60 min after Trendelenburg (T5), 10 min after pneumoperitoneum cessation (T6), 5 min after extubation (T7). Airway peak pressure (Ppeak) and airway plateau pressure (Pplat) were recorded. The value of dynamic lung compliance (Cdyn), spiro-index (RI), dying cavity rate (VD/VT), oxygenation index (PaO2/FiO2) and alveolar arterial PO2 difference (A-aDO2) were calculated at different time points.
ResultsPpeak of group Mm and group m were more stable than Ppeak of group M and group C at T3 and T4 (P<0.05). Pplat of group Mm and group m were more stable than Pplat of group M and group C at T3 and T5 (P<0.05). Oxygenation indexes of group Mm and group m were higher than indexes of group M and group C at T5-T7 (P<0.05). A-aDO2 and RI were lower than group M and group C at T4, T5, T7 (P<0.05). At T4-T6, Cdyn was higher than Cdyn in group M and group C (P<0.05).
ConclusionsManipulative pulmonary protective ventilation can improve the pulmonary function in patients undergoing robotic assisted laparoscopic radical prostatectomy under multimode monitoring.
Key words:
Robot; Therapeutic laparoscopy; Protective lung ventilation; Multi-mode monitoring; Prostate cancer
Contributor Information
Wang Ting
Department of Anesthesiology, the First Affiliated Hospital of University of Science and Technology of China, Southern District of Anhui Provincial Hospital, Hefei 230036, China
Chen Ke
Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
Wang Yiqiao
Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
Lu Xianfu
Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
Li Yuanhai
Department of Anesthesiology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
