• Felix Girrbach, David Petroff, Susann Schulz, Gunther Hempel, Mirko Lange, Carolin Klotz, Stephanie Scherz, Antonio Giannella-Neto, Alessandro Beda, Alcendino Jardim-Neto, Jens-Uwe Stolzenburg, Andreas W Reske, Hermann Wrigge, and Philipp Simon.
• Department of Anaesthesiology and Intensive Care, University of Leipzig Medical Centre, Leipzig, Germany; Innovation Centre Computer Assisted Surgery, University of Leipzig, Leipzig, Germany.
• Br J Anaesth. 2020 Sep 1; 125 (3): 373-382.

BackgroundRobot-assisted laparoscopic radical prostatectomy requires general anaesthesia, extreme Trendelenburg positioning and capnoperitoneum. Together these promote impaired pulmonary gas exchange caused by atelectasis and may contribute to postoperative pulmonary complications. In morbidly obese patients, a recruitment manoeuvre (RM) followed by individualised PEEP improves intraoperative oxygenation and end-expiratory lung volume (EELV). We hypothesised that individualised PEEP with initial RM similarly improves intraoperative oxygenation and EELV in non-obese individuals undergoing robot-assisted prostatectomy.MethodsForty males (age, 49-76 yr; BMI <30 kg m-2) undergoing prostatectomy received volume-controlled ventilation (tidal volume 8 ml kg-1 predicted body weight). Participants were randomised to either (1) RM followed by individualised PEEP (RM/PEEPIND) optimised using electrical impedance tomography or (2) no RM with 5 cm H2O PEEP. The primary outcome was the ratio of arterial oxygen partial pressure to fractional inspired oxygen (Pao2/Fio2) before the last RM before extubation. Secondary outcomes included regional ventilation distribution and EELV which were measured before, during, and after anaesthesia. The cardiovascular effects of RM/PEEPIND were also assessed.ResultsIn 20 males randomised to RM/PEEPIND, the median PEEPIND was 14 cm H2O [inter-quartile range, 8-20]. The Pao2/Fio2 was 10.0 kPa higher with RM/PEEPIND before extubation (95% confidence interval [CI], 2.6-17.3 kPa; P=0.001). RM/PEEPIND increased end-expiratory lung volume by 1.49 L (95% CI, 1.09-1.89 L; P<0.001). RM/PEEPIND also improved the regional ventilation of dependent lung regions. Vasopressor and fluid therapy was similar between groups, although 13 patients randomised to RM/PEEPIND required pharmacological therapy for bradycardia.ConclusionIn non-obese males, an individualised ventilation strategy improved intraoperative oxygenation, which was associated with higher end-expiratory lung volumes during robot-assisted laparoscopic prostatectomy.Clinical Trial RegistrationDRKS00004199 (German clinical trials registry).Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

17 keywords...

hide…