Cardiorespiratory changes during robotic pelvic surgeries- A prospective observational Study

Mohammad Shoaib, Suniti Kale, Deepti Saigal

Abstract


Introduction: Robot assisted pelvic surgeries are associated with cardiorespiratory changes due to conjunction of carboperitoneum and steep Trendelenburg position for prolonged durations.
Aim: To determine the changes in cardiovascular and respiratory systems in patients undergoing elective robot assisted pelvic surgeries under general anesthesia.
Materials and Methods: A prospective observational study was conducted in 35 patients scheduled for elective robot assisted pelvic surgeries. Patients belonging to ASA class I and II were included and their intraoperative hemodynamic and respiratory parameters were noted post induction (baseline), at pneumoperitoneum, at and every 15 minutes after steep Trendelenburg positioning, at resuming supine position, at deflation of pneumoperitoneum and post-deflation. Primary outcome was mean arterial pressure. Secondary outcomes were systolic and diastolic blood pressures, heart rate, central venous
pressure, airway pressures (peak, plateau and mean), pulmonary compliance, minute ventilation, end tidal carbondioxide levels and blood gas values.
Results: On assuming steep Trendelenburg position, there was significant increase in systolic, mean and diastolic blood pressures. There was significant increase in peak, plateau and mean airway pressures and significant decrease in pulmonary compliance which led to increase in end tidal carbondioxide levels and minute ventilation. On resuming supine position and deflation of pneumoperitoneum, there was significant decrease in mean arterial pressure. Although the pulmonary compliance improved, it continued to be significantly lower than the post-induction baseline value.
Conclusion: Robot-assisted pelvic surgeries are associated with significant changes in hemodynamic and respiratory parameters of patients.

Keywords: Hemodynamic monitoring, Pneumoperitoneum, Robotassistedsurgery, Respiratory.


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