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Robotik Yardımlı Radikal Prostatektomi Vakalarında Anestezi Uygulamalarının Retrospektif İncelenmesi

Yıl 2023, Cilt: 6 Sayı: 3, 453 - 457, 31.12.2023
https://doi.org/10.36516/jocass.1318830

Öz

Giriş: Çalışmamızda AÜTF’de opere edilen RYRP olgularında anestezi uygulamamızı; derin trendelenburg, pneumoperitoneum ve cerrahi sebebiyle oluşabilecek hemodinamik değişiklikler ve komplikasyonları incelemeyi ve ilk sonuçlarımızı değerlendirmeyi amaçladık.
Gereç ve Yöntemler:Ocak 2015 – Şubat 2018 tarihleri arasında Akdeniz Üniversitesi Tıp Fakültesi’nde Üroloji Kliniği tarafından prostat adenokarsinomu tanısıyla, RYRP operasyonu yapılan hastalar retrospektif olarak değerlendirilmiştir. Hastaların demografik verileri, intraoperatif hemodinamik ve solunumsal verileri, postoperatif transfer yerleri, ekstübasyon zamanları, ekstübasyon sonrası kan gazı değerleri, komplikasyonlar ve taburculuk zamanları kaydedilmiştir. Elde edilen veriler IBM SPSS® 23.0 programı ile analiz edilmiştir.
Bulgular: Çalışmaya dahil edilen 131 hastanın yaş ortalaması 62,9, VKİ ortalaması 27,6 kg/m2 olarak bulunmuştur. Ayrıca hastalarımızın 47’si ASA-I, 69’u ASA-II, 15’i de ASA-III’tür. Genel değerlendirme sonrası bütün hastalarda intraoperatif dönemde KH, SKB, DKB ve OAB’nin anlamlı olarak azaldığı görüldü. Aynı zamanda pneumoperitoneuma bağlı olarak hastalarda anlamlı şekilde pH düşüşü ve pCO2 yükselmesi olduğu da görüldü. Çalışmamızda, en sık görülen postoperatif komplikasyon bulantı-kusma, ikinci sıklıkta görülen ise anastomoz kaçağı olmuştur. Ancak hiçbir hastamızda kalıcı komplikasyon olmadığı görülmüştür.
Sonuç: RYRP anestezisinin yönetilebilmesi için trendelenburg pozisyonu ve pneumoperitoneumun sistemler üzerine fizyolojik etkilerini ve yaşlılıkta oluşan fizyolojik değişiklikleri bilmek gerekmektedir.

Kaynakça

  • 1.Lee JR. Anesthetic considerations for robotic surgery. Korean J. Anesthesi¬ology. 2014;b66:b3-11. https://doi.org/10.4097/kjae.2014.66.1.3
  • 2.İzdeş S. Robotik cerrahide anestezi. Anestezi Dergisi. 2012;20(2):63-72.
  • 3.Richard LH, Alan DK, Richard DU. Anesthetic challenges in robotic-assisted urologic surgery. Reviews in Urology. 2013; 15(4): 178-84.
  • 4.Daniyal M, Siddiqui ZA, Akram M, et al. Epidemiology, etiology, diagnosis and treatment of prostate cancer. Asian Pac J Cancer Prev. 2014; 15(22): 9575-8. https://doi.org/10.7314/APJCP.2014.15.22.9575
  • 5.Onaca M, Nita G, Manu M, et al. Retroperitonel laparoscopic radical prosta¬tectomy. Chirurgia. 2018; 113(4): 542-50. https://doi.org/10.21614/chirurgia.113.4.542
  • 6.Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radi¬cal prostatectomy. Minerva Anestesiologica. 2012; 78: 596-604.
  • 7.Kadono Y, Yaegashi Y, Machioka K, et al. Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy. Int J Med Robotics Comput Assist Surg. 2013; 9: 17-22. https://doi.org/10.1002/rcs.1482
  • 8.Falabella A, Moore-Jeffries E, Sullivan MJ, et al. Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-as-sisted prostatectomy: a trans-oesophageal Doppler probe study. Int J Med Robotics Comput Assist Surg. 2007; 3: 312-5. https://doi.org/10.1002/rcs.165
  • 9.Danic M, Chow M, Gayload A, et al. Anesthesia consideration for robotic-assisted laparoscopic prostatectomy: a review of 1500 cases. J Robotic Surg 2007; 1: 119-23. https://doi.org/10.1007/s11701-007-0024-z
  • 10.Lebowitz P, Yedlin A, Hakimi AA, et al. Respiratory gas Exchange during robotic-assisted laparoscopic radical prostatectomy. Journal of Clinical An¬esthesia. 2015; 27: 470-5. https://doi.org/10.1016/j.jclinane.2015.06.001
  • 11.Bozkırlı F, Bedirli N, Akçabay M. Efects of steep trendelenburg position and pneumoperitoneum on middle ear pressure in patients undergoing ro-botic radical prostatectomy. Turk J Medi Sci. 2017; 47: 295-9. https://doi.org/10.3906/sag-1601-113
  • 12.Lestar M, Gunnarsson L, Lagerstrand L, et al. Haemodynamic perturba-tions during robot-assisted laparoscopic radical prostatectomy in 45 de-grees trendelenburg position. Anaesthesia and analgesia. 2011; 113(5): 1069-75. https://doi.org/10.1213/ANE.0b013e3182075d1f
  • 13.Piegeler T, Dreessen P, Schlapfer M, et al. Impact of intraoperative fluid management on outcome in patients undergoing robotic-assisted laparo-scopic prostatectomy-a retrospective analysis. Eur J Anaesth Intensive Care. 2011; 28(6): 1-6. https://doi.org/10.1097/00003643-201106001-00256
  • 14.Ono N, Nakahira J, Nakano S, et al. Changes in cardiac function and hemo¬dynamics during robot-assisted laparoscopic prostatectomy with steep head-down tilt: a prospective observational study. BMC Res Notes. 2017; 10: 341-5. https://doi.org/10.1186/s13104-017-2672-z
  • 15.Ozgen US, Ozveren B, Kilercik M, et al. Ischmeia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies? Int. Braz. J Urol. 2016; 42(1): 69-77. https://doi.org/10.1590/S1677-5538.IBJU.2014.0677
  • 16.Oksar M, Akbulut Z, Ocal H, et al. Robotic prostatectomy: the anesthetist's view for robotic urological surgeries, a prospective study. Rev Bras Anestesiol.2014; 64(5): 307-13. https://doi.org/10.1016/j.bjan.2013.10.009
  • 17.Raman JD, Dong S, Levison A, et al. Robotic radical prostatectomy: opera¬tive technique, outcomes, and learning curve. JSLS. 2007; 11: 1-7.
  • 18.Ou YC, Yang CR, Wang J, et al. Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by asingle surgeon. Asian J Surg. 2011; 34(2): 74-80. https://doi.org/10.1016/S1015-9584(11)60023-7
  • 19.Pouget L, Nouhaud FX, Blah M, et al. Interest of surgical companionship during the training periof of robot-assisted radical prostatectomy. Prog Urol. 2017; 27(5): 297-304. https://doi.org/10.1016/j.purol.2017.01.005
  • 20.Mortevazi A, Hermanns T, Hefermehl LJ, et al. Continuous low-dose aspi¬rin theraphy in robotic-assisted laparoscopic radical prostatectomy does not increase risk of surgical hemorrhage. J of Laparoendoscopic and Advanced Surgical Techniques. 2013; 23(6): 500-5. https://doi.org/10.1089/lap.2013.0013
  • 21.Gainsburg DM, Wax D, Reich DL, et al. Intraoperative management of ro-botic-assissted versus open radical prostatectomy. JSLS 2010;14(1):1-5. https://doi.org/10.4293/108680810X12674612014266
  • 22.Nowfar S, Kopp R, Palazzi-Churas K, et al. Initial experience with aspirin use during robotic radical prostatectomy. J of Laparoendoscopic and Ad-vanced Surgical Techniques. 2012; 22(3): 225-9. https://doi.org/10.1089/lap.2011.0388
  • 23.Pradere B, Peyronnet B, Seisen T, et al. Impact of anticoagulant and an-tiplatelet drugs on perioperative outcomes of robotic-assisted partial ne-phrectomy. J.Urol. 2017; 99: 118-22. https://doi.org/10.1016/j.urology.2016.09.009

Retrospectif Analysing of Anesthesia Manegement in Robotic Assisted Radical Prostatectomy Cases

Yıl 2023, Cilt: 6 Sayı: 3, 453 - 457, 31.12.2023
https://doi.org/10.36516/jocass.1318830

Öz

Aim: In our study, we aimed to investigate anesthesia management, hemodynamic changes and complications that may ocur due to steep trendelenburg, pneumoperitoneum and sugery in RARP patients operated in A.U.T.F, and to evaluate our initial results.
Methods: Patients who underwent RARP operation with the diagnosis of prostate adenocarcinoma by the Urology Clinic at Akdeniz University Faculty of Medicine between January 2015 and February 2018 were evaluated retrospectively. Patient’s demographic data, intraoperative hemodynamic and respiratory data, postoperative transfer sites, extubation times, post-extubation blood gas values, complications and discharge times were recorded. Obtained data were analyzed with IBM SPSS® 23.0 program.
Results: We found that mean age of the 131 patients included study was 62 years, and mean BMI was 27,6 kg/m2. Also we found that 47 of patients were ASA-I, 69 of patients were ASA-II and 15 of patients were ASA-III. After general evaluation, it was seen that HR, SBP, DBP and MAP decreased significantly in intraoperative period in all patients. There was also a significant decrease in pH and increase in pCO2 in patients due to pneumoperitoneum. In our study, we found thah the most common postoperative complication was nause and vomiting, and the second common was anastomotic leakage. However, none of our patients had a permanent complication.
Conclusion: In order to manage anesthesia in RARP, it is necessary to know the physiologic effects of trendelenburg position and pneumoperitoneum on the systems and physiological changes in old age.

Kaynakça

  • 1.Lee JR. Anesthetic considerations for robotic surgery. Korean J. Anesthesi¬ology. 2014;b66:b3-11. https://doi.org/10.4097/kjae.2014.66.1.3
  • 2.İzdeş S. Robotik cerrahide anestezi. Anestezi Dergisi. 2012;20(2):63-72.
  • 3.Richard LH, Alan DK, Richard DU. Anesthetic challenges in robotic-assisted urologic surgery. Reviews in Urology. 2013; 15(4): 178-84.
  • 4.Daniyal M, Siddiqui ZA, Akram M, et al. Epidemiology, etiology, diagnosis and treatment of prostate cancer. Asian Pac J Cancer Prev. 2014; 15(22): 9575-8. https://doi.org/10.7314/APJCP.2014.15.22.9575
  • 5.Onaca M, Nita G, Manu M, et al. Retroperitonel laparoscopic radical prosta¬tectomy. Chirurgia. 2018; 113(4): 542-50. https://doi.org/10.21614/chirurgia.113.4.542
  • 6.Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radi¬cal prostatectomy. Minerva Anestesiologica. 2012; 78: 596-604.
  • 7.Kadono Y, Yaegashi Y, Machioka K, et al. Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy. Int J Med Robotics Comput Assist Surg. 2013; 9: 17-22. https://doi.org/10.1002/rcs.1482
  • 8.Falabella A, Moore-Jeffries E, Sullivan MJ, et al. Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-as-sisted prostatectomy: a trans-oesophageal Doppler probe study. Int J Med Robotics Comput Assist Surg. 2007; 3: 312-5. https://doi.org/10.1002/rcs.165
  • 9.Danic M, Chow M, Gayload A, et al. Anesthesia consideration for robotic-assisted laparoscopic prostatectomy: a review of 1500 cases. J Robotic Surg 2007; 1: 119-23. https://doi.org/10.1007/s11701-007-0024-z
  • 10.Lebowitz P, Yedlin A, Hakimi AA, et al. Respiratory gas Exchange during robotic-assisted laparoscopic radical prostatectomy. Journal of Clinical An¬esthesia. 2015; 27: 470-5. https://doi.org/10.1016/j.jclinane.2015.06.001
  • 11.Bozkırlı F, Bedirli N, Akçabay M. Efects of steep trendelenburg position and pneumoperitoneum on middle ear pressure in patients undergoing ro-botic radical prostatectomy. Turk J Medi Sci. 2017; 47: 295-9. https://doi.org/10.3906/sag-1601-113
  • 12.Lestar M, Gunnarsson L, Lagerstrand L, et al. Haemodynamic perturba-tions during robot-assisted laparoscopic radical prostatectomy in 45 de-grees trendelenburg position. Anaesthesia and analgesia. 2011; 113(5): 1069-75. https://doi.org/10.1213/ANE.0b013e3182075d1f
  • 13.Piegeler T, Dreessen P, Schlapfer M, et al. Impact of intraoperative fluid management on outcome in patients undergoing robotic-assisted laparo-scopic prostatectomy-a retrospective analysis. Eur J Anaesth Intensive Care. 2011; 28(6): 1-6. https://doi.org/10.1097/00003643-201106001-00256
  • 14.Ono N, Nakahira J, Nakano S, et al. Changes in cardiac function and hemo¬dynamics during robot-assisted laparoscopic prostatectomy with steep head-down tilt: a prospective observational study. BMC Res Notes. 2017; 10: 341-5. https://doi.org/10.1186/s13104-017-2672-z
  • 15.Ozgen US, Ozveren B, Kilercik M, et al. Ischmeia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies? Int. Braz. J Urol. 2016; 42(1): 69-77. https://doi.org/10.1590/S1677-5538.IBJU.2014.0677
  • 16.Oksar M, Akbulut Z, Ocal H, et al. Robotic prostatectomy: the anesthetist's view for robotic urological surgeries, a prospective study. Rev Bras Anestesiol.2014; 64(5): 307-13. https://doi.org/10.1016/j.bjan.2013.10.009
  • 17.Raman JD, Dong S, Levison A, et al. Robotic radical prostatectomy: opera¬tive technique, outcomes, and learning curve. JSLS. 2007; 11: 1-7.
  • 18.Ou YC, Yang CR, Wang J, et al. Learning curve of robotic-assisted radical prostatectomy with 60 initial cases by asingle surgeon. Asian J Surg. 2011; 34(2): 74-80. https://doi.org/10.1016/S1015-9584(11)60023-7
  • 19.Pouget L, Nouhaud FX, Blah M, et al. Interest of surgical companionship during the training periof of robot-assisted radical prostatectomy. Prog Urol. 2017; 27(5): 297-304. https://doi.org/10.1016/j.purol.2017.01.005
  • 20.Mortevazi A, Hermanns T, Hefermehl LJ, et al. Continuous low-dose aspi¬rin theraphy in robotic-assisted laparoscopic radical prostatectomy does not increase risk of surgical hemorrhage. J of Laparoendoscopic and Advanced Surgical Techniques. 2013; 23(6): 500-5. https://doi.org/10.1089/lap.2013.0013
  • 21.Gainsburg DM, Wax D, Reich DL, et al. Intraoperative management of ro-botic-assissted versus open radical prostatectomy. JSLS 2010;14(1):1-5. https://doi.org/10.4293/108680810X12674612014266
  • 22.Nowfar S, Kopp R, Palazzi-Churas K, et al. Initial experience with aspirin use during robotic radical prostatectomy. J of Laparoendoscopic and Ad-vanced Surgical Techniques. 2012; 22(3): 225-9. https://doi.org/10.1089/lap.2011.0388
  • 23.Pradere B, Peyronnet B, Seisen T, et al. Impact of anticoagulant and an-tiplatelet drugs on perioperative outcomes of robotic-assisted partial ne-phrectomy. J.Urol. 2017; 99: 118-22. https://doi.org/10.1016/j.urology.2016.09.009
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Ömer Uğur 0000-0002-0707-6337

Fatma Ertuğrul Bu kişi benim 0000-0001-7583-3582

Yayımlanma Tarihi 31 Aralık 2023
Kabul Tarihi 29 Kasım 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 6 Sayı: 3

Kaynak Göster

APA Uğur, Ö., & Ertuğrul, F. (2023). Retrospectif Analysing of Anesthesia Manegement in Robotic Assisted Radical Prostatectomy Cases. Journal of Cukurova Anesthesia and Surgical Sciences, 6(3), 453-457. https://doi.org/10.36516/jocass.1318830
https://dergipark.org.tr/tr/download/journal-file/11303