title: Cardiac and hemodynamic consequences during capnoperitoneum and steep Trendelenburg positioning: lessons learned from robot-assisted laparoscopic prostatectomy.
abstract: OBJECTIVE
  To determine and interpret the changes in preload, afterload, and cardiac function in the different phases of robot-assisted laparoscopic prostatectomy.
  
  
  METHODS
  Prospective, observational monocenter study.
  
  
  METHODS
  Operating room at a university hospital.
  
  
  METHODS
  31 consecutive, ASA physical status 1, 2, and 3 patients.
  
  
  METHODS
  Observations were made at 5 distinct time points: baseline after induction of anesthesia, after initiation of capnoperitoneum, immediately after a 45° head-down tilt, 15 minutes after the 45° head-down tilt was established, after the release of the capnoperitoneum, and 5 minutes after the patient was returned to a horizontal position (end).
  
  
  METHODS
  Transpulmonary thermodilution and pulse contour analysis were used to record hemodynamic changes in preload, afterload, and cardiac function.
  
  
  RESULTS
  While central venous pressure increased threefold from baseline, none of the other preload parameters showed excessive fluid overload or demand. There was no significant change in cardiac contractility over time. Afterload increased significantly during the capnoperitoneum and significantly decreased compared with baseline after the release of abdominal pressure at the end of the procedure. Heart rate and cardiac index increased significantly during robot-assisted laparoscopic prostatectomy.
  
  
  CONCLUSIONS
  Selective arterial vasodilation at the time of capnoperitoneum may normalize afterload and myocardial oxygen demand.
authors.affiliation: Hirslanden Clinics Berne, Klinik Beau-Site, Schänzlihalde 11, 3000 Bern 25, Switzerland; Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany. Electronic address: chh7@gmx.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Rosendal
authors.affiliation: Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors.forename: Sergei
authors.initials: S
authors.lastname: Markin
authors.affiliation: Research Training Group 1126, University of Heidelberg, German Research Foundation (DFG), INF 110, 69120 Heidelberg, Germany; Department of Pediatrics, University of Heidelberg, INF 430, 69120 Heidelberg, Germany.
authors.forename: Maximilian D
authors.initials: MD
authors.lastname: Hien
authors.affiliation: Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Motsch
authors.affiliation: Department of Anesthesiology, University of Heidelberg, INF 110, 69120 Heidelberg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Roggenbach
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods; D018475:Head-Down Tilt / Q000502:physiology*; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology; D006785:Hospitals, University; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D012371:Robotics; D013815:Thermodilution / Q000379:methods
keywords: Cardiac output: afterload, preload; Robot-assisted laparoscopic prostatectomy; Transpulmonary thermodiluation