Robotik Radikal Prostatektomide Anestezi Deneyimlerimiz

Year 2020, Volume: 15 Issue: 2, 30 - 34, 08.07.2020

Tuna Şahin , Barış Arslan

https://doi.org/10.17517/ksutfd.677149

Abstract

ÖZET
Amaç: Robotik radikal prostatektomi prostat kanser tedavisinde yaygın olarak uygulanmaktadır. Robot yardımlı laparoskopik radikal prostatektomilerde anestezi yönetimi, hasta yaşı ve profili, operasyon pozisyonu ve süresi nedeniyle özelliklidir. Litotomi, derin Trendelenburg pozisyonu, CO2 pnomoperitonyum nedeniyle kardiyovasküler, respiratuar, nörolojik komplikasyonlar gelişebilir. Bu retrospektif çalışmada robot yardımlı laparoskopik radikal prostatektomi uygulanan hastalardaki anestezi deneyimlerimizi incelemeyi , sonuçlarımızı literarür eşliğinde tartışmayı amaçladık.
Yöntem: Etik kurul onayı alındıktan sonra 1Ocak 2018 ve 30 Eylül 2018 tarihleri arasında robot yardımlı laparoskopik radikal prostatektomi uygulanmış 50 hasta değerlendirildi. Hastalara ait demografik veriler, ASA skorlamaları, ek hastalıklar, intraoperatif anestezi ve analjezi yöntemi, gelişen komplikasyonlar, intravenöz verilen sıvı ve kan miktarı, anestezi süresi, cerrahi süresi, yoğun bakımda kalış süresi, hastanede kalış süresi kaydedildi.
Bulgular: Hastaların yaş ortalaması 63.2±6.2 yıl idi. Anestezi idamesinde en sık inhalasyon anestezisi ( sevofluran veya desfluran) ± opioid (remifentanil) kullanıldığı gözlendi.10 (% 20) hastada bradikardi görülürken, 2(%4) hastada hipotansiyon gelişmiş, 2 (% 4) hastada kan ürünlerine ihtiyaç duyulmuştur. Postoperatif analjezi amaçlı kullanılan ilaçlar tramadol, parasetemol, nonsteroidal antienflamatuar ilaç (NSAİİ), meperedin idi.Hastaların tamamı operasyon masasında extübe edilerek yakın takip amaçlı yoğun bakım ünitesine alındı. Hastaların %96 sı bir gece yoğun bakımda takip edilirken ,hastanede kalış süresi 4.02±1.6 gündü.
Sonuç: Robot yardımlı laparoskopik radikal prostatektomilerde anestezi yönetimi özellikli bir süreçtir. Olası komplikasyonlar için gerekli önlemleri almak, uygun anestezik ajan seçimi, akciğer koruyucu ventilasyon uygulamaları, cerrahi ekip ile koordinasyon anestezi açısından elzemdir.
Anahtar Kelimeler: Prostat kanseri, prostatektomi, anestezi
ABSTRACT
Objective:Robotic radical prostatectomy is commonly used in prostat cancer treatment. Anesthesia management in Robot-assisted laparoscopic radical prostatectomies has specialty due to the age and profile of the patient , operation position and operation time. In this retrospective study we aimed to investigate our anesthesia experiences in patients who underwent Robot-assisted laparoscopic .radical prostatectomy and to discuss the current literature.
Methods:After approval of ethical committee 50 patients who underwent Robot-assisted laparoscopic .radical prostatectomy were investigated between 1 January 2018 and 30 September 2018.Demographic data, ASA scores, comorbidities, intraoperative anesthesia and analgesia management, complications, amounts of fluids and bloods given intravenously , anesthesia duration, surgical duration, duration of intensive care unit and hospital stays were recorded.
Results:Average age of patients was 63.2±6.2 years. Inhalation anesthesia ( sevoflurane or desflurane) ± opioid (remifentanil) was the most anesthesia maintenance preffered. 10 (% 20) patient had bradicardia, 2(%4) patient had hypotension, 2 (% 4) patient received blood transfusion.Drugs used for postoperative analgesia were tramadol, paracetamol, nonsteroidal anti-inflammatory drugs (NSAID), meperedine. All of the patients were extubated in the operating room and were admitted to intensive care unit (ICU). 96 % of patients stayed one night in the ICU. Time of hospital stay was 4.02±1.6 days.
Conclusion: In Robot-assisted laparoscopic radical prostatectomies anesthesia management is a special process. Taking precautions for complications, choice of suitable anesthetic agents ,lung protective strategies, being in concordance with surgical team are essential for anesthesia .
Keywords: Prostate cancer, prostatectomy, anesthesia

Keywords

prostat kanseri, prostatektomi, anestezi

References

• KAYNAKLAR 1- Bivalacqua TJ, Pierorazio PM, Su LM. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach. Surg Oncol 2009; 18: 233-41. 2- Hu JC, Gu X, Lipsitz SR, Barry MJ, D’Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs open radical prostatectomy. JAMA 2009; 302: 1557–64. 3-Menon M, Shrivastava A, Tewari A. Laparoscopic radical prostatectomy: conventional and robotic. Urology 2005; 66: 101–4. 4- D’Alonzo RC, Gan TJ, Moul JW, Albala DM, Polascik TJ, Robertson CN, et al. A retrospective comparison of anesthetic management of robot-assisted laparoscopic radical prostatectomy versus radical retropubic prostatectomy. J Clin Anesth 2009; 21: 322–8. 5- Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy.Minerva Anestesiol 2012; 78: 596–604. 6- Awad H, Walker CM, Shaikh M, Dimitrova GT, Abaza R, O'Hara J. Anesthetic considerations for robotic prostatectomy: a review of the literature. J Clin Anesth. 2012; 24: 494–504. 7- Gainsburg DM, Wax D, Reich DL, Carlucci JR, Samadi DB. Intraoperative management of robotic-assisted versus open radical prostatectomy. JSLS 2010; 14: 1-5. 8- Choi EM, Na S, Choi SH, An J, Rha KH, Oh YJ. Comparison of volume-controlled and pressure-controlled ventilation in steep Trendelenburg position for robot-assisted laparoscopic radical prostatectomy. J Clin Anesth 2011; 23: 183-8. 9- Andersson LE, Baath M, Thorne A, Aspelin P, Odeberg-Wernerman S. Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomography. Anesthesiology 2005; 102: 293-9. 10- Ogurlu M, Kucuk M, Bilgin F, Sizlan A, Yanarates O, Eksert S, et al. Pressure-controlled vs volume-controlled ventilation during laparoscopic gynecologic surgery. J Minim Invasive Gynecol 2010; 17: 295-300. 11- Awad H, Santilli S, Ohr M, Roth A, Yan W, Fernandez S, et al. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg 2009; 109: 473-8. 12- Özdemir M, Bakan N, Şahin ÖT, Kurtçelebi N, Erbeşler ZA, Tunca ST. The Comparison of Sevoflurane-Remifentanyl and Propofol-Remifentanyl in Robotic Prostatectomies.J Clin Anal Med 2013; 4: 313-7. 13- Verdonck P, Kalmar AF, Suy K, Geeraerts T, Vercauteren M, Mottrie A et al.Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy.PLoS One 2014;9:11 e111916. 14-Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 2008; 34: 2062-7. 15-Choi ES, Jeon YT, Sohn HM, Kim DW,Choi SJ, In CB. Comparison of the effects of desflurane and total intravenous anesthesia on the optic nerve sheath diameter in robot assisted laparoscopic radical prostatectomy.Medicine 2018; 97:41 e12772 16- Baltayian S. A brief review: anesthesia for robotic prostatectomy. J Robotic Surg 2008; 2: 59-66. 17- Gupta K, Mehta Y, Sarin Jolly A, Khanna S. Anaesthesia for robotic gynaecological surgery. Anaesth Intensive Care 2012; 40: 614-21. 18-Kim MS, Soh S, Kim SY, Song MS , Park JH. Comparisons of Pressure-controlled Ventilation with Volume Guarantee and Volume-controlled 1:1 Equal Ratio Ventilation on Oxygenation and Respiratory Mechanics during Robot-assisted Laparoscopic Radical Prostatectomy: a Randomized-controlled Trial. Int J Med Sci 2018; 15: 1522-9