title: A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy.
abstract: OBJECTIVE
  To compare anesthetic management and postoperative outcomes in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) and radical retropubic prostatectomy (RRP) with general anesthesia.
  
  
  METHODS
  Retrospective database study of RALP and RRP patients at Duke University Medical Center from 6/2003 to 6/2006.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  541 ASA physical status I, II, and III men, 280 of whom were RRP patients and 256 RALP patients.
  
  
  METHODS
  Patient demographics, intraoperative fluids and blood products, hemodynamic parameters, pain scores in the Postanesthesia Care Unit (PACU), intraoperative and postoperative analgesic consumption, need for rescue antiemetics in the PACU, and intraoperative use of vasopressors and antihypertensives, were all recorded. Additional data included postoperative transfusion data; clinical status of the patient's cancer preoperatively and postoperatively; hematocrit, platelet count, and creatinine levels; and length of hospital stay.
  
  
  RESULTS
  Estimated blood loss (EBL) was higher for RRP than RALP patients (mean +/- SD; 1,087 +/- 853 mL vs. 287 +/- 317 mL; P < 0.0001). Likewise, 24% of RRP patients received red blood cell (RBC) transfusions intraoperatively, compared with 0.4% RALP patients (P < 0.0001). Intraoperatively, RALP patients received more antihypertensive agents (37% vs. 21%; P < 0.0001), and fewer vasopressors (63% vs. 78%; P < 0.0001) than did RRP patients. The two groups had similar morphine-equivalent opioid use intraoperatively, but in the PACU, RALP patients required fewer morphine equivalents (mean +/- SD; 11.4 +/- 7.7 mg vs. 14.9 +/- 9.8 mg; P < 0.0001). The RALP patients had longer surgical times (mean +/- SD; 296 +/- 76 vs.193 +/- 69 min; P < 0.0001) but shorter PACU stays (mean +/- SD; 113 +/- 55 min vs. 143 +/- 58 min; P < 0.0001) and shorter hospital stays (mean +/- SD; 44 +/- 77 hrs vs. 56 +/- 26 hrs; P = 0.009).
  
  
  CONCLUSIONS
  Duration of surgery was greater with RALP, but it was associated with less EBL, fewer transfusions of blood products, and shorter PACU and hospital stays.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: D'Alonzo
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
authors.forename: Judd W
authors.initials: JW
authors.lastname: Moul
authors.forename: David M
authors.initials: DM
authors.lastname: Albala
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Polascik
authors.forename: Cary N
authors.initials: CN
authors.lastname: Robertson
authors.forename: Leon
authors.initials: L
authors.lastname: Sun
authors.forename: Philipp
authors.initials: P
authors.lastname: Dahm
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Habib
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016063:Blood Loss, Surgical / Q000517:prevention & control; D016208:Databases, Factual; D017707:Erythrocyte Transfusion; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D000959:Antihypertensive Agents; D014662:Vasoconstrictor Agents