title: Impact of robot-assisted laparoscopic prostatectomy on the management of general anesthesia: efficacy of blood withdrawal during a steep Trendelenburg position.
abstract: BACKGROUND
  Robot-assisted laparoscopic prostatectomy (RALP) is being increasingly used. However, a steep Trendelenburg position and pneumoperitoneum during RALP has an impact on the respiratory, cardiovascular and cerebrovascular systems. To prevent complications, restrictive fluid management and blood withdrawal have been utilized in our hospital. We examined differences in the anesthetic management between RALP and radical retropubic prostatectomy (RRP), and the efficacy of blood withdrawal.
  
  
  METHODS
  Medical records of patients who underwent radical prostatectomy in our hospital between January 2012 and October 2013 were retrospectively reviewed. Demographic data, intraoperative blood and fluid administration, perioperative complications and the length of hospital stay were compared among patients receiving RRP, and those receiving RALP with and without blood withdrawal (n = 78, 46 and 68, respectively).
  
  
  RESULTS
  Patients receiving RALP with and without blood withdrawal received a smaller volume of crystalloid during surgery than those receiving RRP (mean ± SD, 5.8 ± 2.3 and 4.2 ± 1.6 vs 14.3 ± 4.1 ml/kg/h, p < 0.001). Median estimated blood loss was 885 g (80-2,800 g) for RRP and 50 g for RALP (3-950 g and 3-550 g, respectively), p < 0.001. None of the patients undergoing RALP received red blood cells, but three patients undergoing RRP did so. RALP with blood withdrawal reduced postoperative hospital stay by 45 % (6 vs 11 days). Four patients receiving RALP without blood withdrawal had delayed extubation due to severe laryngeal edema, which did not occur in any of the patients receiving RALP who had blood withdrawal. Renal function did not differ among the groups.
  
  
  CONCLUSIONS
  RALP was associated with less blood loss, no allogeneic transfusion and shorter postoperative hospital stay. This study indicated that blood withdrawal could prevent severe laryngeal edema.
authors.affiliation: Department of Anesthesiology, Hirosaki University Graduate School of Medicine, Hirosaki, 036-8562, Japan, fix-you@hotmail.co.jp.
authors.forename: Junichi
authors.initials: J
authors.lastname: Saito
authors.forename: Satoko
authors.initials: S
authors.lastname: Noguchi
authors.forename: Anna
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Kei
authors.initials: K
authors.lastname: Jinushi
authors.forename: Toshinori
authors.initials: T
authors.lastname: Kasai
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kudo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sawada
authors.forename: Futoshi
authors.initials: F
authors.lastname: Kimura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kushikata
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D001803:Blood Transfusion; D018475:Head-Down Tilt; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics