title: Anesthetic considerations for robotic cystectomy: a prospective study.
abstract: OBJECTIVE
  Robotic cystectomy is rapidly becoming a part of the standard surgical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and hemodynamic challenges and the complications observed in robotic cystectomy patients.
  
  
  METHODS
  Sixteen patients who underwent robotic surgery between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg+pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions.
  
  
  RESULTS
  There were significant differences between T0-T1 and T0-T2 with lower heart rates. The mean arterial pressure value at T1 was significantly lower than T0. The central venous pressure value was significantly higher at T1, T2, T3, and T4 than at T0. There was no significant difference in the PET-CO2 value at any time point compared with T0. There were no significant differences in respiratory rate at any time point compared with T0. The mean f values at T3, T4, and T5 were significantly higher than T0. The mean minute ventilation at T4 and T5 were significantly higher than at T0. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at T0.
  
  
  CONCLUSIONS
  Although the majority of patients generally tolerate robotic cystectomy well and appreciate the benefits, anesthesiologists must consider the changes in the cardiopulmonary system that occur when patients are placed in Trendelenburg position, and when pneumoperitoneum is created.
authors.affiliation: Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey. Electronic address: menekseoksar@gmail.com.
authors.forename: Menekse
authors.initials: M
authors.lastname: Oksar
authors.affiliation: Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Ziya
authors.initials: Z
authors.lastname: Akbulut
authors.affiliation: Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Ocal
authors.affiliation: Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Mevlana Derya
authors.initials: MD
authors.lastname: Balbay
authors.affiliation: Department of Anesthesiology and Reanimation, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Kanbak
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*
keywords: Anesthesia; Anesthesiologist; Robotic cystectomy