Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy

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Presentation transcript:

Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy A.F. Kalmar, L. Foubert, J.F.A. Hendrickx, A. Mottrie, A. Absalom, E.P. Mortier, M.M.R.F. Struys British Journal of Anaesthesia Volume 104, Issue 4, Pages 433-439 (April 2010) DOI: 10.1093/bja/aeq018 Copyright © 2010 The Author(s) Terms and Conditions

Fig 1 Evolution of the individual patient values (thin lines) and the average value (thick line) of the HR, MAP, CVP, CPP, arterial oxygen saturation measured by pulse oximetry (Spo2), and regional cerebral tissue oxygen saturation (Scto2). The curves are synchronized with induction of Trendelenburg position (T). Values are shown from 10 min before T to 240 min after T. The average value is shown up to 180 min of Trendelenburg position. At reassuming the supine position, the curves are resynchronized (S) and values are shown for another 20 min. British Journal of Anaesthesia 2010 104, 433-439DOI: (10.1093/bja/aeq018) Copyright © 2010 The Author(s) Terms and Conditions

Fig 2 Evolution of the individual patient values (thin lines) and the average value (thick line) of the end-tidal CO2 values (Pe′co2), ventilatory plateau pressure (PPlat), TV, and pulmonary compliance. The curves are synchronized with induction of Trendelenburg position (T). Values are shown from 10 min before T to 240 min after T. The average value is shown up to 180 min of Trendelenburg position. At reassuming the supine position, the curves are resynchronized (S) and values are shown for another 20 min. British Journal of Anaesthesia 2010 104, 433-439DOI: (10.1093/bja/aeq018) Copyright © 2010 The Author(s) Terms and Conditions

Fig 3 Evolution of the arterial-to-end-tidal CO2 tension gradient measured just before induction of the peritoneum (S), subsequently at 30 min intervals after Trendelenburg (T1–T9) and 15 (S1) and 30 (S2) min after reassuming the supine position. British Journal of Anaesthesia 2010 104, 433-439DOI: (10.1093/bja/aeq018) Copyright © 2010 The Author(s) Terms and Conditions

Fig 4 The relationship between Paco2 and Pe′co2. Linear regression lines are shown for the pre-, peri- and post-Trendelenburg period. The steeper slope of the regression line in Trendelenburg position reflects an underestimation by the Pe′co2 of the Paco2 at higher Pe′co2 levels. British Journal of Anaesthesia 2010 104, 433-439DOI: (10.1093/bja/aeq018) Copyright © 2010 The Author(s) Terms and Conditions