Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study
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Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study. / Beck, Stefanie; Ragab, Haissam; Hoop, Dennis; Meßner-Schmitt, Aurélie; Rademacher, Cornelius; Kahl, Ursula; von Breunig, Franziska; Haese, Alexander; Graefen, Markus; Zöllner, Christian; Fischer, Marlene.
In: J CLIN MONIT COMPUT, Vol. 35, No. 4, 08.2021, p. 891-901.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study
AU - Beck, Stefanie
AU - Ragab, Haissam
AU - Hoop, Dennis
AU - Meßner-Schmitt, Aurélie
AU - Rademacher, Cornelius
AU - Kahl, Ursula
AU - von Breunig, Franziska
AU - Haese, Alexander
AU - Graefen, Markus
AU - Zöllner, Christian
AU - Fischer, Marlene
N1 - © 2020. The Author(s).
PY - 2021/8
Y1 - 2021/8
N2 - PURPOSE: Surgery in the prolonged extreme Trendelenburg position may lead to elevated intracranial pressure and compromise cerebral hemodynamic regulation. We hypothesized that robot-assisted radical prostatectomy with head-down tilt causes impairment of cerebral autoregulation compared with open retropubic radical prostatectomy in the supine position.METHODS: Patients scheduled for elective radical prostatectomy were included at a tertiary care prostate cancer clinic. Continuous monitoring of the cerebral autoregulation was performed using the correlation method. Based on measurements of cerebral oxygenation with near-infrared spectroscopy and invasive mean arterial blood pressure (MAP), a moving correlation coefficient was calculated to obtain the cerebral oxygenation index as an indicator of cerebral autoregulation. Cerebral autoregulation was measured continuously from induction until recovery from anesthesia.RESULTS: There was no significant difference in cerebral autoregulation between robot-assisted and open retropubic radical prostatectomy during induction (p = 0.089), intraoperatively (p = 0.162), and during recovery from anesthesia (p = 0.620). Age (B = 0.311 [95% CI 0.039; 0.583], p = 0.025) and a higher difference between baseline MAP and intraoperative MAP (B = 0.200 [95% CI 0.073; 0.327], p = 0.002) were associated with impaired cerebral autoregulation, whereas surgical technique was not (B = 3.339 [95% CI 1.275; 7.952], p = 0.155).CONCLUSION: Compared with open radical prostatectomy in the supine position, robot-assisted surgery in the extreme Trendelenburg position with capnoperitoneum did not lead to an impairment of cerebral autoregulation during the perioperative period in our study population.TRIAL REGISTRATION NUMBER: DRKS00010014, date of registration: 21.03.2016, retrospectively registered.
AB - PURPOSE: Surgery in the prolonged extreme Trendelenburg position may lead to elevated intracranial pressure and compromise cerebral hemodynamic regulation. We hypothesized that robot-assisted radical prostatectomy with head-down tilt causes impairment of cerebral autoregulation compared with open retropubic radical prostatectomy in the supine position.METHODS: Patients scheduled for elective radical prostatectomy were included at a tertiary care prostate cancer clinic. Continuous monitoring of the cerebral autoregulation was performed using the correlation method. Based on measurements of cerebral oxygenation with near-infrared spectroscopy and invasive mean arterial blood pressure (MAP), a moving correlation coefficient was calculated to obtain the cerebral oxygenation index as an indicator of cerebral autoregulation. Cerebral autoregulation was measured continuously from induction until recovery from anesthesia.RESULTS: There was no significant difference in cerebral autoregulation between robot-assisted and open retropubic radical prostatectomy during induction (p = 0.089), intraoperatively (p = 0.162), and during recovery from anesthesia (p = 0.620). Age (B = 0.311 [95% CI 0.039; 0.583], p = 0.025) and a higher difference between baseline MAP and intraoperative MAP (B = 0.200 [95% CI 0.073; 0.327], p = 0.002) were associated with impaired cerebral autoregulation, whereas surgical technique was not (B = 3.339 [95% CI 1.275; 7.952], p = 0.155).CONCLUSION: Compared with open radical prostatectomy in the supine position, robot-assisted surgery in the extreme Trendelenburg position with capnoperitoneum did not lead to an impairment of cerebral autoregulation during the perioperative period in our study population.TRIAL REGISTRATION NUMBER: DRKS00010014, date of registration: 21.03.2016, retrospectively registered.
U2 - 10.1007/s10877-020-00549-0
DO - 10.1007/s10877-020-00549-0
M3 - SCORING: Journal article
C2 - 32564173
VL - 35
SP - 891
EP - 901
JO - J CLIN MONIT COMPUT
JF - J CLIN MONIT COMPUT
SN - 1387-1307
IS - 4
ER -
