Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?
The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level o...
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| Veröffentlicht in: | International Brazilian Journal of Urology 2016-01, Vol.42 (1), p.69-77 |
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| creator | Ozgen, Serpil Ustalar Ozveren, Bora Kilercik, Meltem Aksu, Ugur Ay, Binnaz Tufek, Ilter Kural, Ali Riza Turkeri, Levent N Toraman, Fevzi |
| description | The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies.
Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation.
The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery.
(1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p |
| doi_str_mv | 10.1590/S1677-5538.IBJU.2014.0677 |
| format | Article |
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Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation.
The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery.
(1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well.
We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.</description><identifier>ISSN: 1677-5538</identifier><identifier>ISSN: 1677-6119</identifier><identifier>EISSN: 1677-6119</identifier><identifier>EISSN: 1677-5538</identifier><identifier>DOI: 10.1590/S1677-5538.IBJU.2014.0677</identifier><identifier>PMID: 27136469</identifier><language>eng</language><publisher>Brazil: Sociedade Brasileira de Urologia</publisher><subject>Aged ; Albumins ; Analysis of Variance ; Arterial Pressure ; Biomarkers - blood ; Blood Gas Analysis ; Cardiac Output ; Head-Down Tilt ; Hemodynamics ; Humans ; Ischemia ; Ischemia - etiology ; Laparoscopy - methods ; Male ; Middle Aged ; Original ; Patient Positioning - adverse effects ; Patient Positioning - methods ; Pneumoperitoneum, Artificial - adverse effects ; Pneumoperitoneum, Artificial - methods ; Pressure ; Prostatectomy ; Prostatectomy - adverse effects ; Prostatectomy - methods ; Reference Values ; Robotic Surgical Procedures - adverse effects ; Robotic Surgical Procedures - methods ; Robotics ; Serum Albumin ; Serum Albumin, Human ; Splanchnic Circulation ; Time Factors</subject><ispartof>International Brazilian Journal of Urology, 2016-01, Vol.42 (1), p.69-77</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c528t-bd73f81d10a2906a4e5e5e1cc86edb6b6d8f75658e10116896afa7f5ac6a61d23</citedby><cites>FETCH-LOGICAL-c528t-bd73f81d10a2906a4e5e5e1cc86edb6b6d8f75658e10116896afa7f5ac6a61d23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811228/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811228/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27136469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ozgen, Serpil Ustalar</creatorcontrib><creatorcontrib>Ozveren, Bora</creatorcontrib><creatorcontrib>Kilercik, Meltem</creatorcontrib><creatorcontrib>Aksu, Ugur</creatorcontrib><creatorcontrib>Ay, Binnaz</creatorcontrib><creatorcontrib>Tufek, Ilter</creatorcontrib><creatorcontrib>Kural, Ali Riza</creatorcontrib><creatorcontrib>Turkeri, Levent N</creatorcontrib><creatorcontrib>Toraman, Fevzi</creatorcontrib><title>Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?</title><title>International Brazilian Journal of Urology</title><addtitle>Int Braz J Urol</addtitle><description>The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies.
Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation.
The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery.
(1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well.
We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.</description><subject>Aged</subject><subject>Albumins</subject><subject>Analysis of Variance</subject><subject>Arterial Pressure</subject><subject>Biomarkers - blood</subject><subject>Blood Gas Analysis</subject><subject>Cardiac Output</subject><subject>Head-Down Tilt</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Ischemia - etiology</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Patient Positioning - adverse effects</subject><subject>Patient Positioning - methods</subject><subject>Pneumoperitoneum, Artificial - adverse effects</subject><subject>Pneumoperitoneum, Artificial - methods</subject><subject>Pressure</subject><subject>Prostatectomy</subject><subject>Prostatectomy - adverse effects</subject><subject>Prostatectomy - methods</subject><subject>Reference Values</subject><subject>Robotic Surgical Procedures - adverse effects</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Robotics</subject><subject>Serum Albumin</subject><subject>Serum Albumin, Human</subject><subject>Splanchnic Circulation</subject><subject>Time Factors</subject><issn>1677-5538</issn><issn>1677-6119</issn><issn>1677-6119</issn><issn>1677-5538</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNpVkdtq3DAQQEVoaW79haB-wG40tnVxH1qa0CZbAn1o8xjEWBrtKqwtI3sL_fvYu0lokEDDjOZo0GHsE4glyFpc_gal9ULK0ixXVz_vl4WAaimm3BE72ZcUQP3uOZ6vHbPTYXgUoqiFhg_suNBQqkrVJ-xhNbgNtRF5m3wMkTzHbbNrY_eZ-0QDjyN3G-zWxP0ux27N-452beopxzHNIY8dz6lJY3S8z2kYcSQ3pjbS8PWcvQ-4Hejj83nG7n98_3N9u7j7dbO6_na3cLIw46LxugwGPAicJlRYkZwWOGcU-UY1ypugpZKGQAAoUysMqINEp1CBL8oztjpwfcJH2-fYYv5nE0a7T6S8tpinAbdktXclGR2gllg103aFDIq0MEEp2ZiJ9eXA6ndNS95RN2bcvoG-rXRxY9fpr60MQFHMgPoAcNNvDJnCay8IO_uze392FmNnf3b2Z2d_U-_F_4-_dr4IK58A1ZCa7w</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Ozgen, Serpil Ustalar</creator><creator>Ozveren, Bora</creator><creator>Kilercik, Meltem</creator><creator>Aksu, Ugur</creator><creator>Ay, Binnaz</creator><creator>Tufek, Ilter</creator><creator>Kural, Ali Riza</creator><creator>Turkeri, Levent N</creator><creator>Toraman, Fevzi</creator><general>Sociedade Brasileira de Urologia</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>5PM</scope><scope>DOA</scope></search><sort><creationdate>20160101</creationdate><title>Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?</title><author>Ozgen, Serpil Ustalar ; Ozveren, Bora ; Kilercik, Meltem ; Aksu, Ugur ; Ay, Binnaz ; Tufek, Ilter ; Kural, Ali Riza ; Turkeri, Levent N ; Toraman, Fevzi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c528t-bd73f81d10a2906a4e5e5e1cc86edb6b6d8f75658e10116896afa7f5ac6a61d23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Albumins</topic><topic>Analysis of Variance</topic><topic>Arterial Pressure</topic><topic>Biomarkers - blood</topic><topic>Blood Gas Analysis</topic><topic>Cardiac Output</topic><topic>Head-Down Tilt</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Ischemia - etiology</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Patient Positioning - adverse effects</topic><topic>Patient Positioning - methods</topic><topic>Pneumoperitoneum, Artificial - adverse effects</topic><topic>Pneumoperitoneum, Artificial - methods</topic><topic>Pressure</topic><topic>Prostatectomy</topic><topic>Prostatectomy - adverse effects</topic><topic>Prostatectomy - methods</topic><topic>Reference Values</topic><topic>Robotic Surgical Procedures - adverse effects</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Robotics</topic><topic>Serum Albumin</topic><topic>Serum Albumin, Human</topic><topic>Splanchnic Circulation</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ozgen, Serpil Ustalar</creatorcontrib><creatorcontrib>Ozveren, Bora</creatorcontrib><creatorcontrib>Kilercik, Meltem</creatorcontrib><creatorcontrib>Aksu, Ugur</creatorcontrib><creatorcontrib>Ay, Binnaz</creatorcontrib><creatorcontrib>Tufek, Ilter</creatorcontrib><creatorcontrib>Kural, Ali Riza</creatorcontrib><creatorcontrib>Turkeri, Levent N</creatorcontrib><creatorcontrib>Toraman, Fevzi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>International Brazilian Journal of Urology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ozgen, Serpil Ustalar</au><au>Ozveren, Bora</au><au>Kilercik, Meltem</au><au>Aksu, Ugur</au><au>Ay, Binnaz</au><au>Tufek, Ilter</au><au>Kural, Ali Riza</au><au>Turkeri, Levent N</au><au>Toraman, Fevzi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies?</atitle><jtitle>International Brazilian Journal of Urology</jtitle><addtitle>Int Braz J Urol</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>42</volume><issue>1</issue><spage>69</spage><epage>77</epage><pages>69-77</pages><issn>1677-5538</issn><issn>1677-6119</issn><eissn>1677-6119</eissn><eissn>1677-5538</eissn><abstract>The unique positioning of the patient at steep Trendelenburg with prolonged and increased intra-abdominal pressure (IAP) during robotic radical prostatectomy may increase the risk of splanchnic ischemia. We aimed to investigate the acute effects of IAP and steep Trendelenburg position on the level of ischemia modified albumin (IMA) and to test if serum IMA levels might be used as a surrogate marker for possible covert ischemia during robotic radical prostatectomies.
Fifty ASA I-II patients scheduled for elective robotic radical prostatectomy were included in this investigation.
The patients were excluded from the study when an arterial cannulation could not be accomplished, if the case had to be converted to open surgery or if the calculated intraoperative bleeding exceeded 300ml. All the patients were placed in steep (45 degrees) Trendelenburg position following trocar placement. Throughout the operation the IAP was maintained between 11-14mmHg. Mean arterial blood pressure (MAP), cardiac output (CO) were continuously monitored before the induction and throughout the surgery. Blood gases, electrolytes, urea, creatinine, alanine transferase (ALT), aspartate transferase (AST) were recorded. Additionally, IMA levels were measured before, during and after surgery.
(1) MAP, CO, lactate and hemoglobin (Hb) did not significantly change in any period of surgery (p>0.05); (2) sodium (p<0.01), potassium (p<0.05) and urea (p<0.05) levels decreased at postoperative period, and no significant changes at creatinine, AST, ALT levels were observed in these patients; (3) At the end of surgery (180 min) pCO2, pO2, HCO3 and BE did not change compared to after induction values (p>0.05) but mild acidosis was present in these patients (p<0.01 vs. after induction); (4) IMA levels were found to be comparable before induction (0.34±0.04), after induction (0.31±0.06) and at the end of surgery (0.29±0.05) as well.
We did not demonstrate any significant mesenteric-splanchnic ischemia which could be detected by serum IMA levels during robotic radical prostatectomies performed under steep Trendelenburg position and when IAP is maintained in between 11-14 mmHg.</abstract><cop>Brazil</cop><pub>Sociedade Brasileira de Urologia</pub><pmid>27136469</pmid><doi>10.1590/S1677-5538.IBJU.2014.0677</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; PubMed Central Open Access |
| subjects | Aged Albumins Analysis of Variance Arterial Pressure Biomarkers - blood Blood Gas Analysis Cardiac Output Head-Down Tilt Hemodynamics Humans Ischemia Ischemia - etiology Laparoscopy - methods Male Middle Aged Original Patient Positioning - adverse effects Patient Positioning - methods Pneumoperitoneum, Artificial - adverse effects Pneumoperitoneum, Artificial - methods Pressure Prostatectomy Prostatectomy - adverse effects Prostatectomy - methods Reference Values Robotic Surgical Procedures - adverse effects Robotic Surgical Procedures - methods Robotics Serum Albumin Serum Albumin, Human Splanchnic Circulation Time Factors |
| title | Ischemia modified albumin: does it change during pneumoperitoneum in robotic prostatectomies? |
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