Dynamic Arterial Elastance in Predicting Arterial Pressure Increase After Fluid Challenge During Robot-Assisted Laparoscopic Prostatectomy

Background: Blood pressure is controlled by stroke volume and afterload. Arterial load is an effective measure of afterload because it represents all extracardiac factors that oppose left ventricular ejection. Dynamic arterial elastance (Eadyn; pulse pressure variation over stroke volume variation) is a dynamic parameter of arterial load that can be continuously monitored. Eadyn was reported to predict mean arterial pressure (MAP) responsiveness after a fluid challenge. Objective: To assess whether Eadyn can predict MAP responsiveness in acute respiratory distress syndrome (ARDS) patients ventilated with low tidal volume. Materials and Methods: The authors performed a prospective study of diagnostic test accuracy in adult ARDS patients with acute circulatory failure and fluid responsiveness. All patients received continuous blood pressure monitoring via an arterial line connected to a Flotrac™ transducer and Vigileo™ monitor. When the attending physicians decided to load intravenous fluid, the authors recorded the pulse pressure variation over stroke volume variation and other hemodynamic parameters before and after fluid bolus. MAP responsiveness was defined as increased MAP of 10% or more from baseline after fluid challenge. Results: Twenty-three events were included. Nine events (39.13%) were MAP-responsive. Cardiac output, heart rate, and stroke volume were similar in both MAP-responder and MAP-non-responder groups. Baseline MAP, diastolic blood pressure, and pulse pressure were significantly different after fluid challenge in the MAP-responder group. Eadyn of the pre-infusion phase failed to predict MAP responsiveness after fluid challenge (area under the curve 0.603, 95% confidence interval 0.38 to 0.798). Conclusion: Arterial load parameters, including Eadyn, derived from non-calibrated pulse contour analysis failed to predict MAP responsiveness in ARDS patients with low tidal volume ventilation. Keywords: Acute respiratory distress syndrome, Dynamic arterial elastance, Mean arterial pressure, Pulse contour analysis

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Prediction of hypotension after postural change in robot-assisted laparoscopic prostatectomy using esophageal Doppler monitoring: a prospective observational trial

Scientific Reports ◽

10.1038/s41598-021-93990-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Na Young Kim ◽

Ki Jun Kim ◽

Tae Lim Kim ◽

Hye Jung Shin ◽

Chaerim Oh ◽

...

Keyword(s):

Stroke Volume ◽

Volume Index ◽

Esophageal Doppler ◽

Postural Change ◽

Robot Assisted ◽

Arterial Elastance ◽

Abrupt Decrease ◽

Laparoscopic Prostatectomy ◽

Steep Trendelenburg Position ◽

Esophageal Doppler Monitoring

AbstractPostural change from a steep Trendelenburg position to a supine position (T-off) during robot-assisted laparoscopic prostatectomy (RALP) induces a considerable abrupt decrease in the mean arterial pressure (MAP). We investigated the variables for predicting postural hypotension induced by T-off using esophageal Doppler monitoring (EDM). One hundred and twenty-five patients undergoing RALP were enrolled. Data on the MAP, heart rate, stroke volume index (SVI), cardiac index, peak velocity, corrected flow time, stroke volume variation, pulse pressure variation, arterial elastance (Ea), and dynamic arterial elastance were collected before T-off and at 1, 3, 5, 7, and 10 min after T-off using EDM. MAP < 60 mmHg within 10 min after T-off was considered to indicate hypotension, and 25 patients developed hypotension. The areas under the curves of the MAP, SVI, and Ea were 0.734 (95% confidence interval [CI] 0.623–0.846; P < 0.001), 0.712 (95% CI 0.598–0.825; P < 0.001), and 0.760 (95% CI 0.646–0.875; P < 0.001), respectively, with threshold values of ≤ 74 mmHg, ≥ 42.5 mL/m2, and ≤ 1.08 mmHg/mL, respectively. If patients have MAP < 75 mmHg with SVI ≥ 42.5 mL/m2 or Ea ≤ 1.08 mmHg/mL before postural change from T-off during RALP, prompt management for ensuing hypotension should be considered.Trial registration: NCT03882697 (ClinicalTrial.gov, March 20, 2019).

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Robot assisted laparoscopic prostatectomy in liver transplant recipient

Minerva Urologica e Nefrologica ◽

10.23736/s0393-2249.19.03334-4 ◽

2019 ◽

Vol 71 (2) ◽

Author(s):

Kenneth Lim ◽

Riccardo Autorino ◽

Alessandro Veccia ◽

Eduardo B. Zukovksi ◽

Marlon Levy ◽

...

Keyword(s):

Transplant Recipient ◽

Liver Transplant ◽

Liver Transplant Recipient ◽

Robot Assisted ◽

Laparoscopic Prostatectomy

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Pubis-rectum length is a novel factor associated with early recovery of continence following robot-assisted laparoscopic prostatectomy.

10.26226/morressier.59b63e41d462b802923897a2 ◽

2017 ◽

Author(s):

Hiroshi Kiuchi

Keyword(s):

Robot Assisted ◽

Early Recovery ◽

Laparoscopic Prostatectomy

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Effects of pre-emptive pregabalin and multimodal anesthesia on postoperative opioid requirements in patients undergoing robot-assisted laparoscopic prostatectomy

BMC Urology ◽

10.1186/s12894-021-00785-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

K. Sisa ◽

S. Huoponen ◽

O. Ettala ◽

H. Antila ◽

T. I. Saari ◽

...

Keyword(s):

Postoperative Nausea And Vomiting ◽

Multimodal Analgesia ◽

Opioid Consumption ◽

Anesthesia Induction ◽

Anesthesia Care ◽

Post Anesthesia Care Unit ◽

Robot Assisted ◽

Ctrl Group ◽

Laparoscopic Prostatectomy ◽

The Impact

Abstract Background Previous findings indicate that pre-emptive pregabalin as part of multimodal anesthesia reduces opioid requirements compared to conventional anesthesia in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). However, recent studies show contradictory evidence suggesting that pregabalin does not reduce postoperative pain or opioid consumption after surgeries. We conducted a register-based analysis on RALP patients treated over a 5-year period to evaluate postoperative opioid consumption between two multimodal anesthesia protocols. Methods We retrospectively evaluated patients undergoing RALP between years 2015 and 2019. Patients with American Society of Anesthesiologists status 1–3, age between 30 and 80 years and treated with standard multimodal anesthesia were included in the study. Pregabalin (PG) group received 150 mg of oral pregabalin as premedication before anesthesia induction, while the control (CTRL) group was treated conventionally. Postoperative opioid requirements were calculated as intravenous morphine equivalent doses for both groups. The impact of pregabalin on postoperative nausea and vomiting (PONV), and length of stay (LOS) was evaluated. Results We included 245 patients in the PG group and 103 in the CTRL group. Median (IQR) opioid consumption over 24 postoperative hours was 15 (8–24) and 17 (8–25) mg in PG and CTRL groups (p = 0.44). We found no difference in postoperative opioid requirement between the two groups in post anesthesia care unit, or within 12 h postoperatively (p = 0.16; p = 0.09). The length of post anesthesia care unit stay was same in each group and there was no difference in PONV Similarly, median postoperative LOS was 31 h in both groups. Conclusion Patients undergoing RALP and receiving multimodal analgesia do not need significant amount of opioids postoperatively and can be discharged soon after the procedure. Pre-emptive administration of oral pregabalin does not reduce postoperative opioid consumption, PONV or LOS in these patients.

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