The impact of obesity on pulmonary deterioration in patients undergoing robotic-assisted laparoscopic prostatectomy
- 86 Downloads
Obesity affects respiratory and hemodynamic function in anesthetized patients. The aim of this study was to evaluate the influence of the body mass index (BMI) on pulmonary changes in a permanent 45° steep Trendelenburg position (STP) during robotic-assisted laparoscopic prostatectomy (RALP). 51 patients undergoing RALP under standardized anesthesia were included. Perioperative pulmonary function and oxygenation were measured in awake patients (T0), 20 min after the induction of anesthesia (T1), after insufflation of the abdomen in supine position (T2), after 30 min in STP (T3), when controlling Santorini’s plexus in STP (T4), before awakening while supine (T5), and after 45 min in the recovery room (T6). Patient-specific and time-dependent factor on ventilation and predicted peak inspiratory pressure (PIP), driving pressure (Pdriv) and lung compliance (LC) in a linear regression model were calculated. PIP and Pdriv increased significantly after induction of capnoperitoneum (T2–4) (p < 0.0001). In univariate mixed effects models, BMI was found to be a significant predictor for PIP and Pdriv increase and LC decrease. Obese patients a BMI > 31 kg/m2 reached critical PIP values ≥ 35 cmH2O. Postoperative oxygenation represented by the PaO2/FiO2 ratio was significantly decreased compared to T0 (p < 0.0001). Obesity in combination with STP and capnoperitoneum during RALP has a profound effect on pulmonary function. Increased PIP and Pdriv and decreased LC are directly correlated with a high BMI. Changes in PIP, Pdriv and LC during RALP may be predicted in relation to patient’s BMI for consideration in the preoperative setting. Trial registration number Z-2014-0387-6. Registered on 8 July 2014.
KeywordsLung compliance Driving pressure Obesity Peak inspiratory pressure Robotic-assisted laparoscopic prostatectomy Steep Trendelenburg position
American Society of Anesthesia
Body mass index
End tidal CO2
Inspiratory fraction of oxygen
Mean arterial blood pressure
Partial arterial carbon dioxide fraction
Partial arterial oxygen fraction
Positive end-expiratory pressure
Peak inspiratory pressure
Robotic-assisted laparoscopic prostatectomy
Steep Trendelenburg position
Total intravenous anesthesia
Availability of data and material
All data generated or analyzed during this study are included in this published article and are available from the corresponding author on reasonable request.
SB: Ethics approval, study design, data collection and analysis, drafted the manuscript and reviewed it for important intellectual content; MH: Idea for study, study design, patient recruitment, data collection and finally reviewed the manuscript for important intellectual content; FZ: Data analysis and interpretation, finally reviewed the manuscript for important intellectual content; TS: Made acquisitions, interpret data and finally reviewed the manuscript for important intellectual content; ML: Made acquisitions, interpret data and finally reviewed the manuscript for important intellectual content; MB: Made acquisitions, interpret data and finally reviewed the manuscript for important intellectual content; SD: Made acquisitions and interpret of data and finally reviewed the manuscript for important intellectual content; MP: Idea for study, study design, data collection and interpretation, patient recruitment and finally reviewed the manuscript for important intellectual content.
Compliance with ethical standards
Conflict of interest
The authors declares that they have no competing interest in relation to this paper.
This study was approved by the local institutional review board of the University of Regensburg (Protocol No. 14-101-0107) and registered at the local Center for Clinical Studies (Z-2014-0387-6. Registered on 8 July 2014).
After detailed explanation, written informed consent was obtained from 51 patients scheduled for elective prostatectomy at the Department of Urology in Regensburg.
- 6.Consultation on Obesity. Obesity: preventing and managing the global epidemic: report of a WHO consultation. Geneva: WHO; 2000.Google Scholar
- 7.Mensink GBM, Schienkiewitz A, Haftenberger M, Lampert T, Ziese T, Scheidt-Nave C. Ubergewicht und Adipositas in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56:786–94.CrossRefPubMedGoogle Scholar
- 10.Rodriguez C, Patel AV, Calle EE, Jacobs EJ, Chao A, Thun MJ. Body mass index, height, and prostate cancer mortality in two large cohorts of adult men in the United States. Cancer Epidemiol Biomark Prev. 2001;10:345–53.Google Scholar
- 22.Holm BA, Finkelstein JN, Notter RH, editors. Lung injury: mechanisms, pathophysiology, and therapy. Boca Raton: Taylor & Francis; 2005.Google Scholar
- 23.Neto AS, Hemmes SNT, Barbas CSV, Beiderlinden M, Fernandez-Bustamante A, Futier E, et al. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016;4:272–80.CrossRefPubMedGoogle Scholar
- 25.Blecha S, Harth M, Schlachetzki F, Zeman F, Blecha C, Flora P, et al. Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45 degrees Trendelenburg position. BMC Anesthesiol. 2017;17:40.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Kalmar AF, Foubert L, Hendrickx JFA, Mottrie A, Absalom A, Mortier EP, Struys MMRF. Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010;104:433–9.CrossRefPubMedGoogle Scholar
- 31.Nestler C, Simon P, Petroff D, Hammermüller S, Kamrath D, Wolf S, et al. Individualized positive end-expiratory pressure in obese patients during general anaesthesia: a randomized controlled clinical trial using electrical impedance tomography. Br J Anaesth. 2017;119:1194–205.CrossRefPubMedGoogle Scholar
- 34.Bluth T, Teichmann R, Kiss T, Bobek I, Canet J, Cinnella G, et al. Protective intraoperative ventilation with higher versus lower levels of positive end-expiratory pressure in obese patients (PROBESE): study protocol for a randomized controlled trial. Trials. 2017;18:202.CrossRefPubMedPubMedCentralGoogle Scholar