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Journal of Robotic Surgery

, Volume 9, Issue 1, pp 19–25 | Cite as

Cerebral tissue O2 saturation during prolonged robotic surgery in the steep Trendelenburg position: an observational case series in a diverse surgical population

  • Laura Lahaye
  • Mario Grasso
  • Jeffrey Green
  • C. J. Biddle
Original Article
  • 309 Downloads

Abstract

Demands associated with the Trendelenburg position (TP) are well known yet there is little attention given to regional cerebral tissue O2 saturation (SctO2) in those undergoing robotic surgery in the TP with CO2 insufflation (C-INSF). This is the first study to report on SctO2 in a wide range of patients undergoing lengthy TP and robotic surgery. We measured SctO2 during robotic surgery in patients in the TP with C-INSF, as well as a control robotic thyroid surgery group who were supine with no C-INSF. We recorded relevant variables and periods of cerebral desaturation (CD). We studied 42 patients in 25°–45° of TP for ≥125 min. Management was at the providers’ discretion. The INVOS® 5100C Cerebral Oximeter (Covidien, Boulder, CO) recorded SctO2. CD was defined as a >20 % decrease from baseline SctO2 or a value ≤55 % for ≥10 min. Patients were assessed for adverse outcome. The sample consisted of 13 males and 29 females aged 22–73, BMI 22–36 had general (N = 3), urological (N = 14) and gynecological (N = 25) surgery; two patients had CD lasting 150 and 190 min and two had episodic CD lasting 10–35 min. The four were female aged 22–60 in 38°–45° of TP. Eleven cases had multiple episodic CD for ≤15 min, 27 TP cases had no CD. Other observations included a consistent fall in SctO2 with phenylephrine; an increased SctO2 with ephedrine; and FiO2 and EtCO2 being generally strong, direct modifiers of SctO2. High MAP was inconsistently associated with high SctO2. BMI had no observed effect on SctO2. Pulse oximetry was ≥97 % in all cases. We observed no adverse cerebral events on follow-up. Additional clinical studies are warranted.

Keywords

Robotic surgery Cerebral tissue oxygenation Steep trendelenburg position Phenylephrine 

Notes

Conflict of interest

Lahaye, Biddle, and Grasso declare that they have no conflict of interest. Green has received research funding and consulting fees from Covidien.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was waived for all patients included in this study by our institutional review board.

References

  1. 1.
    Park EY, Koo BN, Min KT, Nam SH (2009) The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand 53:895–899CrossRefPubMedGoogle Scholar
  2. 2.
    Kalmar AF, Dewaele F, Foubert L et al (2012) Cerebral haemodynamic physiology during steep Trendelenburg position and CO2 pneumoperitoneum. Br J Anaesth 108:478–484CrossRefPubMedGoogle Scholar
  3. 3.
    Kalmar AF, Foubert L, Henrickx JF et al (2010) Influence of steep Trendelenburg postion and carbon dioxide pneumoperitoneum on cardiaovascular, cerebrovascular and respiratory homeostasis during robotic prostatectomy. Br J Anaesth 104:433–439CrossRefPubMedGoogle Scholar
  4. 4.
    Soeding PF, Wang J, Hoy G et al (2011) The effect of the sitting upright tor ‘beachchair’ position on cerebral blood flow during anaesthesia for shoulder surgery. Anaesth Intensive Care 39:440–448PubMedGoogle Scholar
  5. 5.
    Papadonikolakis A, Wiesler ER, Olympio MA, Poehling GG (2008) Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position. Arthroscopy 24:481–482CrossRefPubMedGoogle Scholar
  6. 6.
    Lanier W (2009) Special editorial—cerebral perfusion: err on the side of caution. APSF Newsl 24:1–4Google Scholar
  7. 7.
    McCulloch TJ, Liyanagama K, Petchell J (2010) Relative hypotension in the beach-chair position: effects on middle cerebral artery blood velocity. Anaesth Intensive Care 38:486–491PubMedGoogle Scholar
  8. 8.
    Lee JH, Min KT, Chun YM, Kim EJ, Choi SH (2011) Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery. Arthroscopy 27:889–894CrossRefPubMedGoogle Scholar
  9. 9.
    Murphy GS, Szokol JW, Marymont JH et al (2010) Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions. Anesth Analg 111:496–505CrossRefPubMedGoogle Scholar
  10. 10.
    Lovell AT, Owen-Reece H, Elwell CE, Smith M, Goldstone JC (1999) Continuous measurement of cerebral oxygenation by near infrared spectroscopy during induction of anesthesia. Anesth Analg. 88:554–559PubMedGoogle Scholar
  11. 11.
    Ghosh A, Elwell C, Smith M (2012) Cerebral near-infrared spectroscopy in adults: a work in progress. Anesth Analg. 115:1373–1383CrossRefPubMedGoogle Scholar
  12. 12.
    Menon M, Shrivastava A, Tewari A (2005) Laparoscopic radical prostatectomy: conventional and robotic. Urology 66:101–104CrossRefPubMedGoogle Scholar
  13. 13.
    Meng L, Connessor M, Alexander B et al (2011) Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth 107:209–217CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Soeding PF, Hoy S, Hoy G, Evans M, Royse C (2013) Effect of phenyleprhine on the haemodynamic state and cerebral oxygen saturation during anaesthetsia in the upright position. Br J Anaesth 111:229–234CrossRefPubMedGoogle Scholar
  15. 15.
    Hendrikse J, van Raamt AF, van der Graff Y, Mali WP, van der Grond J (2005) Distribution of cerebral blood flow in the circle of Willis. Radiology 235:184–189CrossRefPubMedGoogle Scholar
  16. 16.
    Drummond JC, Hargens AR, Patel PM (2009) Special editorial—hydrostatic gradient is important, blood pressure should be corrected. APSF Newsl 24:5Google Scholar
  17. 17.
    Kirby RR, Cullen DJ (2009) Special editorial—lower limit of autoregulation questioned. APSF Newsl 24:6Google Scholar
  18. 18.
    Park EY, Koo BN, Min KT, Nam SH (2009) The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand 53:895–899CrossRefPubMedGoogle Scholar
  19. 19.
    Kalmar AF, Foubert L, Hendrickx JFA et al (2010) Influence of steep Trendelenburg position and carbon dioxide pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth 104:433–439CrossRefPubMedGoogle Scholar
  20. 20.
    Halverson A, Buchanan R, Jacobs L et al (1998) Evaluation of mechanism of increased intracranial pressure with insufflations. Surg Endosc. 12:266–269CrossRefPubMedGoogle Scholar
  21. 21.
    Closhen D, Treiber AH, Berres M et al (2014) Robotic assisted prostatic surgery in the Trendelenburg position does not impair cerebral oxygenation measured using two different monitors. Eur J Anaesthesiol 31:104–109CrossRefPubMedGoogle Scholar
  22. 22.
    Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S (2007) Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol 24:59–65PubMedGoogle Scholar
  23. 23.
    Dunham CM, Sosnowski C, Porter JM, Siegal J, Kohli C (2002) Correlation of noninvasive cerebral oximetry with cerebral perfusion in the severe head injured patient: a pilot study. J Trauma 52:225–228CrossRefGoogle Scholar
  24. 24.
    Fischer GW (2008) Recent advances in the application of cerebral oximetry in adult cardiovascular surgery. Semin Cardiothorac Vasc Anesth. 12:60–69CrossRefPubMedGoogle Scholar
  25. 25.
    Murkin JM, Arango JM (2009) Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth 103(Suppl):i3–i13CrossRefPubMedGoogle Scholar
  26. 26.
    Moeerman A, Wouters P (2010) Near-infrared spectroscopy monitoring in contemporary anesthesia and critical care. Acta Anaesth Belg. 61:185–194Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Laura Lahaye
    • 1
  • Mario Grasso
    • 1
  • Jeffrey Green
    • 1
  • C. J. Biddle
    • 1
  1. 1.Department of AnesthesiologyVirginia Commonwealth UniversityRichmondUSA

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