Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic‐assisted prostatic surgery
Summary Trendelenburg positioning in combination with pneumoperitoneum during robotic‐assisted prostatic surgery possibly impairs cerebrovascular autoregulation. If cerebrovascular autoregulation is disturbed, arterial hypertension might induce cerebral hyperaemia and brain oedema, while low arteria...
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| Veröffentlicht in: | Anaesthesia 2014-01, Vol.69 (1), p.58-63 |
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| creator | Schramm, P. Treiber, A.‐H. Berres, M. Pestel, G. Engelhard, K. Werner, C. Closhen, D. |
| description | Summary
Trendelenburg positioning in combination with pneumoperitoneum during robotic‐assisted prostatic surgery possibly impairs cerebrovascular autoregulation. If cerebrovascular autoregulation is disturbed, arterial hypertension might induce cerebral hyperaemia and brain oedema, while low arterial blood pressure can induce cerebral ischaemia. The time course of cerebrovascular autoregulation was investigated during use of the Trendelenburg position and a pneumoperitoneum for robotic‐assisted prostatic surgery using transcranial Doppler ultrasound. Cerebral blood flow velocity was correlated with arterial blood pressure and the autoregulation index (Mx) was calculated. In 23 male patients, Mx was assessed at baseline, after induction of general anaesthesia, during the Trendelenburg position (40–45°), and after repositioning. During the Trendelenburg position, Mx increased over time, indicating an impairment of cerebrovascular autoregulation. After repositioning, Mx recovered to baseline levels. It can be concluded that with longer durations of Trendelenburg position and pneumoperitoneum, cerebrovascular autoregulation deteriorates, and, therefore, blood pressure management should be adapted to avoid cerebral oedema and the duration of Trendelenburg position should be as short as possible. |
| doi_str_mv | 10.1111/anae.12477 |
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Trendelenburg positioning in combination with pneumoperitoneum during robotic‐assisted prostatic surgery possibly impairs cerebrovascular autoregulation. If cerebrovascular autoregulation is disturbed, arterial hypertension might induce cerebral hyperaemia and brain oedema, while low arterial blood pressure can induce cerebral ischaemia. The time course of cerebrovascular autoregulation was investigated during use of the Trendelenburg position and a pneumoperitoneum for robotic‐assisted prostatic surgery using transcranial Doppler ultrasound. Cerebral blood flow velocity was correlated with arterial blood pressure and the autoregulation index (Mx) was calculated. In 23 male patients, Mx was assessed at baseline, after induction of general anaesthesia, during the Trendelenburg position (40–45°), and after repositioning. During the Trendelenburg position, Mx increased over time, indicating an impairment of cerebrovascular autoregulation. After repositioning, Mx recovered to baseline levels. It can be concluded that with longer durations of Trendelenburg position and pneumoperitoneum, cerebrovascular autoregulation deteriorates, and, therefore, blood pressure management should be adapted to avoid cerebral oedema and the duration of Trendelenburg position should be as short as possible.</description><identifier>ISSN: 0003-2409</identifier><identifier>EISSN: 1365-2044</identifier><identifier>DOI: 10.1111/anae.12477</identifier><identifier>PMID: 24256501</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Aged ; Anesthesia ; Blood Flow Velocity - physiology ; Blood Pressure - physiology ; Brain ; Brain Edema - etiology ; Brain Edema - prevention & control ; CAS ; Cerebrovascular Circulation - physiology ; Computer assisted surgery ; Head-Down Tilt - adverse effects ; Head-Down Tilt - physiology ; Homeostasis - physiology ; Humans ; Hypertension ; Male ; Middle Aged ; Middle Cerebral Artery - diagnostic imaging ; Middle Cerebral Artery - physiopathology ; Monitoring, Intraoperative - methods ; Patient Positioning - adverse effects ; Patient Positioning - methods ; Pneumoperitoneum, Artificial - adverse effects ; Prospective Studies ; Prostate ; Prostatectomy - methods ; Robotics - methods ; Time Factors ; Ultrasonography, Doppler, Transcranial - methods</subject><ispartof>Anaesthesia, 2014-01, Vol.69 (1), p.58-63</ispartof><rights>2013 The Association of Anaesthetists of Great Britain and Ireland</rights><rights>2013 The Association of Anaesthetists of Great Britain and Ireland.</rights><rights>Copyright © 2014 The Association of Anaesthetists of Great Britain and Ireland</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5257-9121bd1b1be2c1a8712cb1da33c3c0f19468689c28cb5cee59a8d95211f6da683</citedby><cites>FETCH-LOGICAL-c5257-9121bd1b1be2c1a8712cb1da33c3c0f19468689c28cb5cee59a8d95211f6da683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fanae.12477$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fanae.12477$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,1433,27924,27925,45574,45575,46409,46833</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24256501$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schramm, P.</creatorcontrib><creatorcontrib>Treiber, A.‐H.</creatorcontrib><creatorcontrib>Berres, M.</creatorcontrib><creatorcontrib>Pestel, G.</creatorcontrib><creatorcontrib>Engelhard, K.</creatorcontrib><creatorcontrib>Werner, C.</creatorcontrib><creatorcontrib>Closhen, D.</creatorcontrib><title>Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic‐assisted prostatic surgery</title><title>Anaesthesia</title><addtitle>Anaesthesia</addtitle><description>Summary
Trendelenburg positioning in combination with pneumoperitoneum during robotic‐assisted prostatic surgery possibly impairs cerebrovascular autoregulation. If cerebrovascular autoregulation is disturbed, arterial hypertension might induce cerebral hyperaemia and brain oedema, while low arterial blood pressure can induce cerebral ischaemia. The time course of cerebrovascular autoregulation was investigated during use of the Trendelenburg position and a pneumoperitoneum for robotic‐assisted prostatic surgery using transcranial Doppler ultrasound. Cerebral blood flow velocity was correlated with arterial blood pressure and the autoregulation index (Mx) was calculated. In 23 male patients, Mx was assessed at baseline, after induction of general anaesthesia, during the Trendelenburg position (40–45°), and after repositioning. During the Trendelenburg position, Mx increased over time, indicating an impairment of cerebrovascular autoregulation. After repositioning, Mx recovered to baseline levels. It can be concluded that with longer durations of Trendelenburg position and pneumoperitoneum, cerebrovascular autoregulation deteriorates, and, therefore, blood pressure management should be adapted to avoid cerebral oedema and the duration of Trendelenburg position should be as short as possible.</description><subject>Aged</subject><subject>Anesthesia</subject><subject>Blood Flow Velocity - physiology</subject><subject>Blood Pressure - physiology</subject><subject>Brain</subject><subject>Brain Edema - etiology</subject><subject>Brain Edema - prevention & control</subject><subject>CAS</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Computer assisted surgery</subject><subject>Head-Down Tilt - adverse effects</subject><subject>Head-Down Tilt - physiology</subject><subject>Homeostasis - physiology</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery - diagnostic imaging</subject><subject>Middle Cerebral Artery - physiopathology</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Patient Positioning - adverse effects</subject><subject>Patient Positioning - methods</subject><subject>Pneumoperitoneum, Artificial - adverse effects</subject><subject>Prospective Studies</subject><subject>Prostate</subject><subject>Prostatectomy - methods</subject><subject>Robotics - methods</subject><subject>Time Factors</subject><subject>Ultrasonography, Doppler, Transcranial - methods</subject><issn>0003-2409</issn><issn>1365-2044</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqN0ctO3DAUBmALtYLhsuEBkKVuEFKojxM7znKEoCCN2s10HdnOycgoEw92QjsSCx6BZ-RJ6mEGFl1U9cZefP59-Qk5BXYJaXzVvcZL4EVZ7pEJ5FJknBXFJzJhjOUZL1h1QA5jvGcMuAK1Tw54wYUUDCbkae6WSK0fQ0TqW2oxoAn-UUc7djpQPQ4-4CKtB-d72ozB9QuKv4eAad88YN9gh70Zw4KufHRvqvWBBm_84Ozr84uO0cUBG7oKPg4px9KYOIb1Mfnc6i7iyW4-Ij9vrudXt9nsx7e7q-kss4KLMquAg2nAgEFuQasSuDXQ6Dy3uWUtVIVUUlWWK2uERRSVVk0lOEArGy1VfkTOt7npBg8jxqFeumix63SPfow1FJVUCoDL_6CyZFKUJUv0y1_0Pn1jnx6SVMkZZ0Jtzr7YKpteHwO29Sq4pQ7rGli9qa_e1Fe_1Zfw2S5yNEtsPuh7XwnAFvxyHa7_EVVPv0-vt6F_AM_FqC0</recordid><startdate>201401</startdate><enddate>201401</enddate><creator>Schramm, P.</creator><creator>Treiber, A.‐H.</creator><creator>Berres, M.</creator><creator>Pestel, G.</creator><creator>Engelhard, K.</creator><creator>Werner, C.</creator><creator>Closhen, D.</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>201401</creationdate><title>Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic‐assisted prostatic surgery</title><author>Schramm, P. ; Treiber, A.‐H. ; Berres, M. ; Pestel, G. ; Engelhard, K. ; Werner, C. ; Closhen, D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5257-9121bd1b1be2c1a8712cb1da33c3c0f19468689c28cb5cee59a8d95211f6da683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Anesthesia</topic><topic>Blood Flow Velocity - physiology</topic><topic>Blood Pressure - physiology</topic><topic>Brain</topic><topic>Brain Edema - etiology</topic><topic>Brain Edema - prevention & control</topic><topic>CAS</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Computer assisted surgery</topic><topic>Head-Down Tilt - adverse effects</topic><topic>Head-Down Tilt - physiology</topic><topic>Homeostasis - physiology</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery - diagnostic imaging</topic><topic>Middle Cerebral Artery - physiopathology</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Patient Positioning - adverse effects</topic><topic>Patient Positioning - methods</topic><topic>Pneumoperitoneum, Artificial - adverse effects</topic><topic>Prospective Studies</topic><topic>Prostate</topic><topic>Prostatectomy - methods</topic><topic>Robotics - methods</topic><topic>Time Factors</topic><topic>Ultrasonography, Doppler, Transcranial - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schramm, P.</creatorcontrib><creatorcontrib>Treiber, A.‐H.</creatorcontrib><creatorcontrib>Berres, M.</creatorcontrib><creatorcontrib>Pestel, G.</creatorcontrib><creatorcontrib>Engelhard, K.</creatorcontrib><creatorcontrib>Werner, C.</creatorcontrib><creatorcontrib>Closhen, D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>Anaesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schramm, P.</au><au>Treiber, A.‐H.</au><au>Berres, M.</au><au>Pestel, G.</au><au>Engelhard, K.</au><au>Werner, C.</au><au>Closhen, D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic‐assisted prostatic surgery</atitle><jtitle>Anaesthesia</jtitle><addtitle>Anaesthesia</addtitle><date>2014-01</date><risdate>2014</risdate><volume>69</volume><issue>1</issue><spage>58</spage><epage>63</epage><pages>58-63</pages><issn>0003-2409</issn><eissn>1365-2044</eissn><abstract>Summary
Trendelenburg positioning in combination with pneumoperitoneum during robotic‐assisted prostatic surgery possibly impairs cerebrovascular autoregulation. If cerebrovascular autoregulation is disturbed, arterial hypertension might induce cerebral hyperaemia and brain oedema, while low arterial blood pressure can induce cerebral ischaemia. The time course of cerebrovascular autoregulation was investigated during use of the Trendelenburg position and a pneumoperitoneum for robotic‐assisted prostatic surgery using transcranial Doppler ultrasound. Cerebral blood flow velocity was correlated with arterial blood pressure and the autoregulation index (Mx) was calculated. In 23 male patients, Mx was assessed at baseline, after induction of general anaesthesia, during the Trendelenburg position (40–45°), and after repositioning. During the Trendelenburg position, Mx increased over time, indicating an impairment of cerebrovascular autoregulation. After repositioning, Mx recovered to baseline levels. It can be concluded that with longer durations of Trendelenburg position and pneumoperitoneum, cerebrovascular autoregulation deteriorates, and, therefore, blood pressure management should be adapted to avoid cerebral oedema and the duration of Trendelenburg position should be as short as possible.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>24256501</pmid><doi>10.1111/anae.12477</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Access via Wiley Online Library; EZB-FREE-00999 freely available EZB journals; Wiley Online Library (Open Access Collection) |
| subjects | Aged Anesthesia Blood Flow Velocity - physiology Blood Pressure - physiology Brain Brain Edema - etiology Brain Edema - prevention & control CAS Cerebrovascular Circulation - physiology Computer assisted surgery Head-Down Tilt - adverse effects Head-Down Tilt - physiology Homeostasis - physiology Humans Hypertension Male Middle Aged Middle Cerebral Artery - diagnostic imaging Middle Cerebral Artery - physiopathology Monitoring, Intraoperative - methods Patient Positioning - adverse effects Patient Positioning - methods Pneumoperitoneum, Artificial - adverse effects Prospective Studies Prostate Prostatectomy - methods Robotics - methods Time Factors Ultrasonography, Doppler, Transcranial - methods |
| title | Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic‐assisted prostatic surgery |
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