Anesthetic considerations for robotic cystectomy: a prospective study

Background and objectives: Robotic cystectomy is rapidly becoming a part of the standard surAnesthesia; gical repertoire for the treatment of prostate cancer. Our aim was to describe respiratory and Anesthesiologist hemodynamic challenges and the complications observed in robotic cystectomy patients. Patients: 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 (To), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions. Results: There were significant differences between To T1 and To T2 with lower heart rates. The mean arterial pressure value at Ti was significantly lower than To. The central venous pressure value was significantly higher at Ti, 12, T3, and 14 than at T. There was no significant difference in the PET-CO2 value at any time point compared with To. There were no significant differences in respiratory rate at any time point compared with To. The mean f values at T3, T4, and T5 were significantly higher than To. The mean minute ventilation at T4 and T5 were significantly higher than at To. The mean plateau pressures and peak pressures at T1, T2, T3, T4, and T5 were significantly higher than the mean value at To. 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. (C) 2013 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.