Prostatic Neoplasm, Urinary Bladder Neoplasm
Conditions
Brief summary
Gas exchange disturbance frequently occurs in steep Trendelenburg position during robot-assisted laparoscopic prostatectomy or cystectomy. Due to increased intrathoracic pressure and absorbed carbon dioxide (CO2) gas insufflated into abdominal cavity, hypercapnia as well as hypoxia may occur. Inverse ratio ventilation or prolonged inspiratory time during mechanical ventilation has been reported to be improve gas exchange in adult respiratory distress syndrome. The investigators attempt to test the hypothesis that prolonged inspiratory time may improve the gas exchange during robot-assisted laparoscopic urologic surgery.
Detailed description
Gas exchange disturbance frequently occurs in steep Trendelenburg position during robot-assisted laparoscopic prostatectomy or cystectomy. Due to increased intrathoracic pressure and absorbed CO2 gas insufflated into abdominal cavity, hypercapnia as well as hypoxia may occur. Inverse ratio ventilation or prolonged inspiratory time during mechanical ventilation has been reported to be improve gas exchange in adult respiratory distress syndrome. The investigators attempt to test the hypothesis that prolonged inspiratory time (I:E ratio = 1:1) may improve the gas exchange during robot-assisted laparoscopic urologic surgery.
Interventions
DEVICEAdjustment of Mechanical Ventilator Inspiratory to expiratory time ratio (1:2 to 1:1)
Adjustment of Mechanical Ventilator Inspiratory to expiratory time ratio (1:2 to 1:1)
DEVICEAdjustment of Mechanical Ventilator Inspiratory to expiratory time ratio (1:1 to 1:2)
Adjustment of Mechanical Ventilator Inspiratory to expiratory time ratio (1:1 to 1:2)
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
MALE
Age
20 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
* American Society of Anesthesiologists physical status class I-II and scheduled for an elective robot-assisted laparoscopic radical prostatectomy or robot-assisted laparoscopic radical cystectomy * Patients who voluntarily decides to participate in the trial and has agreed in written informed consent
Exclusion criteria
* Patients with the anatomical abnormalities of respiratory system(abnormal airway anatomy, severe scoliosis, post-pneumonectomy state), severe chronic respiratory diseases, chronic obstructive pulmonary disease (COPD), asthma, heart failure, obesity ( Body Mass Index \[BMI\] \> 30kg/m2), severe hepatic failure or renal failure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PaCO2 (mmHg) in the patient's arterial blood gas analysis | 60 min after the initiation of pneumoperitoneum with steep Trendelenburg positioning | PaCO2 (arterial partial pressure of carbon dioxide) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PaCO2 (mmHg) in the patient's arterial blood gas analysis | 5 minutes after anesthesia induction | PaCO2 (arterial partial pressure of carbon dioxide) |
| PaO2 (mmHg) in the patient's arterial blood gas analysis | 5 minutes after anesthesia induction | PaO2 (arterial partial pressure of oxygen) |
| Respiratory compliance (Static, Dynamic) | 5 minutes after anesthesia induction | Static compliance = exhaled tidal volume / (plateau pressure - PEEP), Dynamic compliance = Exhaled tidal volume / (PIP - PEEP) |
| oxygen index | 5 minutes after anesthesia induction | oxygen index calculated by PaO2/inspired oxygen fraction |
| Alveolar-arterial oxygen difference | 5 minutes after anesthesia induction | — |
Countries
South Korea
Outcome results
None listed