Authors: Dirk Meininger Klaus Westphal Dorothee H Bremerich Heiner Runkel Michael Probst Bernhard Zwissler Christian Byhahn
Publish Date: 2008/01/29
Volume: 32, Issue: 7, Pages: 1400-1405
Abstract
Ten American Society of Anesthesiologists ASA physical status I–III patients undergoing totally endoscopic robotassisted radical prostatectomy were enrolled in the study Invasive hemodynamic parameters were measured by transpulmonary arterial thermodilution using the PiCCO® system with a femoral artery catheter Cardiac index CI heart rate HR mean arterial pressure MAP systemic vascular resistance index SVRI intrathoracic blood volume ITBV and central venous pressure CVP were recorded with the patient in the supine position after headdown tilt intraoperatively after 30 min 1 h 2 h 3 h and 4 h of pneumoperitoneum at an insufflation pressure of 12 mmHg after deflation still with headdown positioning and finally with the patient in the supine positionPlacing the patient in the Trendelenburg headdown position caused a significant increase in CVP from 99 ± 34 to 151 ± 23 mmHg whereas all other hemodynamic parameters remained nearly unaffected The induction of pneumoperitoneum resulted in a significant increase in MAP from 749 ± 129 to 954 ± 119 mmHg No other parameter was affected Even at 4 h of pneumoperitoneum only mild hemodynamic changes were observed After release of the pneumoperitoneum with the patient still in the headdown position HR 490 ± 4 versus 639 ± 124 min−1 and after placing the patient in the supine position CI 24 ± 02 versus 33 ± 07 l min−1 m−2 increased significantly whereas CVP returned to baseline values
Keywords: