title: Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-assisted prostatectomy: a trans-oesophageal Doppler probe study.
abstract: BACKGROUND
  Haemodynamic changes associated with pneumoperitoneum and steep Trendelenburg position were investigated in non-obese, ASA I-II males, using general anaesthesia (sevoflurane in air/O2, 40%) undergoing robotic-assisted laparoscopic prostatectomy.
  
  
  METHODS
  A trans-oesophageal echo-Doppler probe (Arrow International) measured cardiovascular changes in heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV) and aortic diameter (AoD) in 35 of 37 males. Assessments were conducted after induction of general anaesthesia in: the supine position; at 45 degrees Trendelenburg; Trendelenburg + pnuemoperitoneum (intra-abdominal 15 mmHg); and at the end of surgery in the supine position.
  
  
  RESULTS
  The Trendelenburg position increased stroke volume. Trendelenburg position + pneumoperitoneum increased MAP and SVR and decreased AoD.
  
  
  CONCLUSIONS
  Pneumoperitoneum and steep Trendelenburg position significantly increase MAP and SVR. Trendelenburg position increased stroke volume. Pneumoperitoneum decreases aortic diameter. No significant changes in cardiac output or stroke volume were noted.
authors.affiliation: Department of Anesthesiology, City of Hope National Medical Center, Duarte, CA 91010-3000, USA.
authors.forename: Andres
authors.initials: A
authors.lastname: Falabella
authors.forename: Earl
authors.initials: E
authors.lastname: Moore-Jeffries
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sullivan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Nelson
authors.forename: Michael
authors.initials: M
authors.lastname: Lew
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002245:Carbon Dioxide; D017548:Echocardiography, Transesophageal; D006321:Heart / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D011187:Posture / Q000502:physiology*; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*
chemical_list: D002245:Carbon Dioxide