title: Effects of prolonged pneumoperitoneum on hemodynamics and acid-base balance during totally endoscopic robot-assisted radical prostatectomies.
abstract: Laparoscopic techniques have become a standard approach for diagnostic and therapeutic procedures in many surgical disciplines. Recent progress in endoscopic surgery is based on the integration of computer-enhanced telemanipulation systems. Because robot-assisted radical prostatectomies take up to 10 hours, the present study was performed to evaluate the effects of prolonged intraperitoneal CO2 insufflation on hemodynamics and gas exchange in 15 patients with prostate cancer. When CO2 insufflation was initiated, peak inspiratory pressure increased and reached significant values after a 1.5-hour period of intraperitoneal CO2 insufflation. With the release of CO2, peak inspiratory pressure decreased close to baseline values. A significant increase in heart rate was observed after a 4-hour period of increased intraabdominal pressure. Mean arterial blood pressure and central venous pressure remained stable during CO2 insufflation. Minute ventilation was adjusted according to repeated blood gas analyses to maintain pH, base excess (BE), bicarbonate (HCO3?), and PaCO2 within physiologic ranges. The present data show, that prolonged CO2 insufflation during totally endoscopic robot-assisted radical prostatectomy results in only minor changes in hemodynamics and acid-base status. Because of the limited experience with long-term pneumoperitoneum, we consider invasive haemodynamic monitoring and repeat blood gas analysis essential for such operations.
authors.affiliation: Department of Anesthesiology, Intensive Care Medicine, and Pain Control, JW Goethe-University Hospital Center, Theodor-Stern-Kai 7, D-60590, Frankfurt, Germany. dirk_meininger@gmx.de
authors.forename: Dirk
authors.initials: D
authors.lastname: Meininger
authors.forename: Christian
authors.initials: C
authors.lastname: Byhahn
authors.forename: Matthias
authors.initials: M
authors.lastname: Bueck
authors.forename: Jochen
authors.initials: J
authors.lastname: Binder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kramer
authors.forename: Paul
authors.initials: P
authors.lastname: Kessler
authors.forename: Klaus
authors.initials: K
authors.lastname: Westphal
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology*; D001784:Blood Gas Analysis; D002496:Central Venous Pressure; D015331:Cohort Studies; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects* / Q000379:methods; D011336:Probability; D011446:Prospective Studies; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome