Evaluation of Cardiac Functions in Robotic-assisted Prostatectomy Surgery Performed Under Deep Trendelenburg Position
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 30
- 试验地点
- 1
- 主要终点
- Cardiac cycle efficiency (CCE) was measured for evaluating cardiac performance
研究概览
简要总结
Robotic-assisted laparoscopic prostatectomy (RALP) is a surgical method with good short-term results and accepted as the gold standard because of its minimal invasiveness. The pneumoperitoneum and deep Trendelenburg position (at least 25°-45° upside down) required for RALP surgeries can cause significant pathophysiological changes in both the pulmonary and cardiac systems, as well as complicate hemodynamic management.
In this study, investigators aimed to determine the changes in the cardiovascular system during deep Trendelenburg position with the hemodynamic parameters monitored by the pressure record analytical method (PRAM) and the Longitudinal Strain measured with simultaneous transesophageal echocardiography.
详细描述
RALP is the gold standard surgical technique in prostate surgery. Many Robotic-laparoscopic surgical techniques also require the intraoperative deep Trendelenburg position. However, the possible side effects of the deep Trendelenburg position on the cardiovascular system during surgery are unknown. Although the Trendelenburg position is a life-saving maneuver in hypovolemic patients, it also carries undesirable risks. Although the increase in venous return is expected to protect the cardiac output (CO) in the deep Trendelenburg position, the increase in intrathoracic pressure due to the intraperitoneal pressure may cause deterioration in venous return and a decrease in CO . In addition, the changing heart configuration in the deep Trendelenburg position may also cause an increase in the workload of the heart. Therefore, the need to evaluate hemodynamic management with advanced monitoring techniques, including fluid therapy in the perioperative period, has arisen in patients undergoing RALP.
The pressure Recording Analytical Method (PRAM), is one of the most up-to-date monitoring methods designed for continuous CO measurement derived from the arterial pressure wave analysis, with a high signal sampling rate (1000 Hz). Many studies have shown that PRAM is a reliable monitoring method in major surgery. Cardiac Cycle Efficiency (CCE), which the PRAM method adds to our daily practice, is an index that defines hemodynamic performance in terms of energy consumption and efficiency. It can be expressed as the ratio of systolic energy performance to the total energy expenditure of the cardiac cycle and indicates the ability of the cardiovascular system to maintain homeostasis at different energy levels. However, data on how cardiac functions change in the deep Trendelenburg position are still limited.
In this study, investigators aimed to demonstrate the reliability of the CCE value through its correlation with the Longitudinal Strain (LS) by observing the effect of the deep Trendelenburg position in RALP surgeries on cardiac functions using PRAM and Transesophageal Echocardiography (TEE).
研究设计
- 研究类型
- Observational
- 观察模型
- Case Only
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 100 Years（Adult, Older Adult）
- 性别
- Male
- 接受健康志愿者
- 否
入选标准
- •Patients with American Society Of Anesthesiology physical status 1-3
- •Underwent Robotic-assisted laparoscopic prostatectomy
- •Patients with intra-arterial blood pressure monitoring before anesthesia induction.
排除标准
- •Under 18 years of age
- •Arrhythmia (atrial fibrillation, frequent premature beat)
- •History of myocardial infarction in the last 3 months
- •Heart failure
- •Severe pre-existing lung disease
- •Severe valvular heart disease
- •Chronic renal disease on dialysis,
结局指标
主要结局
Cardiac cycle efficiency (CCE) was measured for evaluating cardiac performance
时间窗: The duration of the measurement was defined from one minute before induction to the end of the surgery
CCE(unit) indicates the ability of the cardiovascular system to maintain homeostasis at different energy levels. CCE was monitored using the uncalibrated pulse contour device MostCare (Vytech, Vygon, Padova, Italy)
Longitudinal strain rate (LSR) was measured for evaluating cardiac performance
时间窗: LSR was measured at supine position and 10 minute after trendelenburg position
LSR (%) is a parameter that shows the rate of dimensional change that occurs in the heart muscle. It is an indicator of the systolic functions of the left ventricle. LSR was calculated by intraoperative transesophageal echocardiography.
Longitudinal strain (LS) was measured for evaluating cardiac performance
时间窗: LS was measured at supine position and 10 minute after trendelenburg position
LS (%) is a parameter that shows the percentage of dimensional change that occurs in the heart muscle. It is an indicator of the systolic functions of the left ventricle. LS was calculated by intraoperative transesophageal echocardiography.
次要结局
- Diastolic arterial pressure (DAP) was measured for evaluating perfusion pressure(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Heart rate (HR) was measured for evaluating heart ritm(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Cardiac index (CI) was measured for evaluating cardiac flow(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Mean arterial pressure (MAP) was measured for evaluating perfusion pressure(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Pulse pressure variation (PPV) was measured for evaluation of volume status(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Stroke volume variation (SVV) was measured for evaluation of volume status(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Dp/Dt was measured to assess cardiac systolic function(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Systemic vascular resistance index (SVRI) was measured for evaluating peripheric vascular resistance(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Cardiac power output (CPO) was measured for evaluation of cardiac power reserve(The duration of the measurement was defined from one minute before induction to the end of the surgery)
- Systolic arterial pressure (SAP) was measured for evaluating perfusion pressure(The duration of the measurement was defined from one minute before induction to the end of the surgery)