Blecha, Sebastian and Harth, Marion and Zeman, Florian and Seyfried, Timo and Lubnow, Matthias and Burger, Maximilian and Denzinger, Stefan and Pawlik, Michael T. (2019) The impact of obesity on pulmonary deterioration in patients undergoing robotic-assisted laparoscopic prostatectomy. JOURNAL OF CLINICAL MONITORING AND COMPUTING, 33 (1). pp. 133-143. ISSN 1387-1307, 1573-2614
Full text not available from this repository. (Request a copy)Abstract
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 degrees 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 (T-0), 20 min after the induction of anesthesia (T-1), after insufflation of the abdomen in supine position (T-2), after 30 min in STP (T-3), when controlling Santorini's plexus in STP (T-4), before awakening while supine (T-5), and after 45 min in the recovery room (T-6). Patient-specific and time-dependent factor on ventilation and predicted peak inspiratory pressure (PIP), driving pressure (P-driv) and lung compliance (LC) in a linear regression model were calculated. PIP and P-driv 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 P-driv increase and LC decrease. Obese patients a BMI > 31 kg/m(2) reached critical PIP values >= 35 cmH(2)O. Postoperative oxygenation represented by the PaO2/FiO(2) ratio was significantly decreased compared to T-0 (p < 0.0001). Obesity in combination with STP and capnoperitoneum during RALP has a profound effect on pulmonary function. Increased PIP and P-driv and decreased LC are directly correlated with a high BMI. Changes in PIP, P-driv and LC during RALP may be predicted in relation to patient's BMI for consideration in the preoperative setting.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | END-EXPIRATORY PRESSURE; RADICAL PROSTATECTOMY; GENERAL-ANESTHESIA; DRIVING PRESSURE; BODY-MASS; LUNG; OVERWEIGHT; MORTALITY; COMPLICATIONS; VENTILATION; Lung compliance; Driving pressure; Obesity; Peak inspiratory pressure; Robotic-assisted laparoscopic prostatectomy; Steep Trendelenburg position |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie Medicine > Lehrstuhl für Innere Medizin II Medicine > Lehrstuhl für Urologie Medicine > Zentren des Universitätsklinikums Regensburg > Zentrum für Klinische Studien |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 22 Apr 2020 09:47 |
| Last Modified: | 22 Apr 2020 09:47 |
| URI: | https://pred.uni-regensburg.de/id/eprint/27688 |
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