Comparison of Volume-controlled and Pressure-controlled Ventilation in Clasp-knife Position

Not Applicable

Completed

• Conditions: Mechanical Ventilation; Urological Surgery; General Anesthesia; Robotic Surgery
• Interventions: Behavioral: record Hemodynamic variables, respiratory variables and arterial blood gas at specific times

• Registration Number: NCT06056401
• Lead Sponsor: Sun Yat-sen University

Brief Summary

Carbon dioxide (CO2) pneumoperitoneum and clasp-knife positioning are commonly used to improve surgical access during robot-assisted laparoscopic urological surgery. However, these methods are sometimes associated with several unwanted cardiopulmonary effects such as increased mean arterial pressure, decreased pulmonary compliance and functional residual capacity, increased peak inspiratory pressure, and respiratory acidosis in association with hypercarbia. Volume-controlled ventilation (VCV) is the most commonly used method of ventilation during general anesthesia. It provides fixed minute ventilation and pulmonary resistance, which affect airway pressure. In pressure-controlled ventilation (PCV), constant inspiratory airway pressure can be achieved by decelerating the flow. However, minute ventilation is not fixed . CO2 pneumoperitoneum in the clasp-knife positioning can influence hemodynamic variables, including blood pressure, heart rate, and cardiac output. This is because changes in airway pressure affect intrathoracic pressure and the function of the heart itself. In this randomized study, we investigated the effects of VCV and PCV on peak inspiratory pressure during robot-assisted laparoscopic urological surgery involving CO2 pneumoperitoneum in the clasp-knife position.

Detailed Description

After careful screening, 60 patients were enrolled in the trial. The investigators monitored patients' breathing, circulation and carbon metabolism by measuring arterial gas, cardiac output monitoring, respiratory parameters and circulation parameters at different times in both groups of patients.

Study Timeline

• Study Start: 2022-10-15
• Primary Completion: 2023-02-24
• Study Completion: 2023-02-24
• Study First Submitted: 2023-03-08
• Status Verified: 2023-09
• Study First Submitted QC: 2023-09-20
• Last Update Submitted: 2023-09-20
• Study First Posted: 2023-09-28
• Last Update Posted: 2023-09-28

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• Patients undergoing urological surgery in clasp-knife position
• between the age of 18 and 65
• America Society of Anesthesiologist Grades I-II.

Exclusion Criteria

• Morbid obesity
• systolic blood pressure < 90 mmHg)
• heart rate < 60 beats per minute or > 100 beats per minute
• peripheral blood oxygen saturation < 90%
• Complicated with severe liver and kidney injury.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
PCV group	record Hemodynamic variables, respiratory variables and arterial blood gas at specific times	For patients assigned in this group, after standard anesthesia, in which the following drugs were used (midazolam 0.05 mg / kg;propofol 1.5-2.5 mg / kg; sufentanil 0.3-0.5 μg / kg; and cisatracurium0.2-0.3 mg / kg), their mechanical ventilation mode was adjusted to the PCV mode.
VCV group	record Hemodynamic variables, respiratory variables and arterial blood gas at specific times	For patients assigned in this group, after standard anesthesia, in which the following drugs were used (midazolam 0.05 mg / kg;propofol 1.5-2.5 mg / kg; sufentanil 0.3-0.5 μg / kg; and cisatracurium0.2-0.3 mg / kg), their mechanical ventilation mode was adjusted to the VCV mode.

Primary Outcome Measures

Name	Time	Method
Check the patient's ventilation effect at a specific time	T5(15 minutes after pneumoperitoneum was released)	we recorded the patients' peak inspiratory pressure

Trial Locations

Locations (1)

Cai Xinyuan; 🇨🇳 Guangzhou, Guangdong, China