Lung Collapse
Conditions
Brief summary
In the case of robotic prostate cancer surgery under general anesthesia, the surgical posture is extreme Trendelenburg. Therefore, airway pressure is very high during mechanical ventilation, and there is a possibility of postoperative pulmonary complications. In order to prevent postoperative pulmonary complications, we tried to apply end-tidal pressure suitable for each individual to set the most tidal volume that can reduce the burden on the lungs during the perioperative period.
Detailed description
This study is conducted on patients who are scheduled for prostate surgery under general anesthesia with robot assistance. Subjects who consented to the consent form the day before the surgery were conducted with people aged 19 years or older who belonged to the American Society of Anesthesiologists (ASA) class I or II. In the drive group, the ventilator setting is fixed at tidal volume 6-8ml/kg and respiratory rate 15 breathes/min, and then the recruitment maneuver (RM, alveolar recruitment) is performed within the range that does not cause hemodynamic instability. After that, the PEEP is gradually raised from 5 cmH2O to 20 cmH2O. Driving pressure finds the lowest value. If there is no significant change even when the pressure change raises the PEEP, select the lowest PEEP. In the control group, PEEP is maintained in 5 cmH2O until the end of surgery. The primary outcome of the study is to confirm the presence or absence of postoperative pulmonary complications using Chest X-rays, vital signs, and blood tests. It is the individualized PEEP value as a secondary outcome. The related driving pressure and compliance will also be observed. In addition, anesthesia/surgical time, use of vasopressors, amount of blood loss, amount of fluid, and amount of urine will be measured.
Interventions
OTHERDriving pressure group
individual PEEP
Sponsors
Seoul National University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
OTHER
Masking
SINGLE (Subject)
Masking description
Because a table of random numbers is used, participants do not know which group they belong to.
Intervention model description
In the drive group, the ventilator setting is fixed at tidal volume 6-8ml/kg and respiratory rate 15 breathes/min, and then the recruitment maneuver (RM, alveolar recruitment) is performed within the range that does not cause hemodynamic instability. After that, the PEEP is gradually raised from 5 cmH2O to 20 cmH2O. Driving pressure finds the lowest value. If there is no significant change even when the pressure change raises the PEEP, select the lowest PEEP. In the control group, PEEP is maintained in 5 cmH2O until the end of surgery.
Eligibility
Sex/Gender
MALE
Age
19 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
* elective RALP surgery under genenal anesthesia * ASA 1-2 * 19 years of age or older * Consented to participate in the study
Exclusion criteria
* Do not consent to participate in the study * ≥ BMI 40 kg/m2 * Moderate or severe obstructive/restrictive pulmonary disease on pulmonary function tests * Preoperative serious cardiovascular disease * Required postoperative ventilator care at ICU care
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Post operative pulmonary complication(PPC) | up to PostOperative Day(POD) #3 | Post operative lung complication |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Individual ventilatory setting | during opertaion | PEEP in cmH2O at mechanical ventilation setting static lung compliance in liters/cmH2O at measured mechanical ventilation and calculated driving pressure in cmH20 Driving pressure (DP or ΔP) is defined as the distending pressure above the applied positive end-expiratory pressure (PEEP) required to generate tidal volume (VT) * C stat= tidal volume/ Driving pressure * Driving pressure= tidal volume/C stat |
| blood pressure(hypotension) | during opertaion | Types and dosages of vasopressor agents used when the mean blood pressure is ≤ 60 mmHg. \*\* vasopressor agents: Ephedrine, phenylepherine, Norepinepherine * Ephedrine single intravenous injection: 5mg * phenylepherine single intravenous injection: 20mcg continueous infusion: mcg/kg/min at 100mcg/cc * Norepinepherine continueous infusion: mcg/kg/min at 10mcg/cc |
Countries
South Korea
Outcome results
None listed