Obese Patients With Prostate Cancer Disease
Conditions
Keywords
obese patients, specific elastance, Trendelenburg Position, Pneumoperitoneum, robotic surgery, Prostatectomy
Brief summary
Analysis of the specific elastance during general anesthesia in patients treated with RARP (robotic assisted radical prostatectomy), to evaluate the efficacy of the preemptive strategy, involving recruitment maneuver and setting of 10 cmH2O PEEP before induction of pneumoperitoneum and trendelenburg position.
Detailed description
RARP (robotic assisted radical prostatectomy) requires the induction of pneumoperitoneum and the trendelenburg position, causing increase in the intra-abdominal pressure and cephalic shift of the diaphragm, with consequent airway closure and collapse of the dependent regions of the lung. Obese subjects present an increased risk of respiratory complications, caused not only by the surgical procedure itself, but also by the respiratory mechanics changes associated with the body mass. In obese patients we can observe higher values of lung and chest wall elastance, with reduction in ventilation-perfusion ratio. The partitioning between lung and chest wall elastance can improve ventilatory setting and mechanics parameters of ventilation. In every patient we will place, after anesthesia induction, a catheter to get esophageal and gastric pressure that represent pleural and abdominal pressure. Ventilation will be conducted with a tidal volume of 8-10 ml/kg (IBW) and a respiratory rate adequate to maintain a physiological level of Pa CO2. The preemptive strategy involves recruitment maneuver and setting of 10 cmH2O PEEP before induction of pneumoperitoneum and trendelenburg position in the treatment group, while the current procedure provides it afterwards (control group).
Interventions
OTHERtreatment
preemptive PEEP before pneumoperitoneum and trendelenburg
OTHERcontrol
PEEP after pneumoperitoneum and trendelenburg
Sponsors
University of Turin, Italy
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
MALE
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* BMI \>= 30 * Robotic-assisted laparoscopic prostatectomy
Exclusion criteria
* Chronic cardiac or pulmonary diseases
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| evaluation of arterial oxygenation | at 6 hours (average duration of surgery procedure) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| evaluation of specific static elastance of the lung | at 6 hours (average duration of surgery procedure) | Evaluation of the elastic properties of the lung (specific static elastance) |
| evaluation of difference between arterial end-tidal partial pressure of carbon dioxide | at 6 hours (average duration of surgery procedure) | difference between arterial end-tidal partial pressure of carbon dioxide is an indicator of lung collapse and reopening after open-lung PEEP, which in turn reduce dead space |
Other
| Measure | Time frame |
|---|---|
| variation of gas exchange in post operative period | at 1 week (average duration) |
Countries
Italy
Outcome results
None listed