Trendelenburg Position
Conditions
Interventions
This is an observational and prospective study where 48 adults patients undergoing laparoscopic or robotic surgery performed under Trendelemburg position will be monitored for the development of alter
V03.175.500
Sponsors
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Hospital Nove de Julho - Rede Ímpar
Eligibility
Age
40 Years to No maximum
Inclusion criteria
Inclusion criteria: Patients over 40 years of age; undergoing elective gastrointestinal, urological or gynecological surgeries; without previous cognitive alterations; Signature of the consent form
Exclusion criteria
Exclusion criteria: Patient refusal to participate in the clinical trial; previous cognitive alterations; history of ischemic stroke or other previous neurological pathologies
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Expected Outcome 1:It is expected to find an alteration in cerebral compliance following the patient’s positioning in Trendelenburg and pneumoperitoneum insufflation, verified using the Brain4care method, based on the detection of at least a 5% variation between pre- and post-positioning measurements;Observed Outcome 1: The baseline P2/P1 ratio was 0.78 ± 0.17. An alteration in cerebral compliance was observed in 31.25% of patients immediately after Trendelenburg positioning, in half of the 28 patients with a Trendelenburg duration greater than 120 minutes, verified using the Brain4care device and P2/P1 waveform analysis | — |
Secondary
| Measure | Time frame |
|---|---|
| Expected Outcome 2: To identify a correlation between cerebral compliance measurements (P2/P1 ratio), optic nerve sheath diameter, and cerebral oximetry, as well as to identify risk factors associated with altered cerebral compliance;Observed Outcome 2: Patients with reduced cerebral compliance (P2/P1 > 1.2) were older (68.1 ± 6.7 vs. 61.9 ± 9.2 years; p = 0.01), had lower body weight (mean 73.0 vs. 85.4 kg; p = 0.005), presented with longer surgical time (median 210 vs. 170 minutes; p = 0.03), and exhibited a greater postoperative decline in MoCA score (-3 points; p = 0.04). When comparing noninvasive monitoring methods, a positive correlation was observed only between P2/P1 = 1.2 and increased cerebral oximetry after 30 minutes of Trendelenburg positioning | — |
Countries
Brazil
Contacts
Public ContactGabriela Saba
Faculdade de Medicina da Universidade de São Paulo
Outcome results
None listed