Preventing atelectasia at robotic surgery

We read the article "Robotic prostatectomy: the anesthetist's view for robotic urological surgeries, a prospective study" written by Oksar and Ocal with a great interest.¹ They share the anesthetic management of the robotic prostatectomy. We would like to thank to the authors for their contribution with a successfully designed and documented study. We believe that these findings will enlighten about the anesthetic management of the robotic prostatectomy.

Robotic-assisted laparoscopic prostatectomy (RALP) is a technically difficult surgery requiring experience. The duration of the surgery is usually prolonged because of detailed preparation before surgery. The anesthetic management requires more attention than open surgery due to pneumo-peritoneum. Prolonged operation time, the trendelenburg position, and increased intra-abdominal pressure due to pneumo-peritoneum usually lead to severe atelectasis, increased level of PaCO₂ and acidosis.^2-4 However intermittent recruitment maneuver should be made to prevent and improve atelectasis due to pneumo-peritoneum and trendelenburg. Recruitment maneuver especially before extubation may improve postoperative lung functions.⁵

Consequently, effects due to excessive trendelenburg position in addition to classical complications of laparoscopic procedure at robotic-assisted laparoscopic prostate surgery should be considered. Increasing airway pressure is inescapable. Increasing minute ventilation may not be enough to be maintained in the PaCO₂'s normal range. Pressure-control mode forming lower peak pressure should be preferred and appropriate PEEP sould be setted to prevent atelectasis.^5,6 Also intermittant recruitment maneuver should be made as needed.

References

• ¹
  Oksar M, Akbulut Z, Ocal H, et al. Robotic prostatectomy: the anesthetist's view for robotic urological surgeries, a prospective study. Braz J Anesthesiol. 2014;64(5):307-13.
• ²
  Oksar M, Akbulut Z, Ocal H, et al. Anesthetic considerations for robotic cystectomy: a prospective study. Braz J Anesthesiol. 2014;64(2):109-15.
• ³
  Hypolito O, Azevedo JL, Gama F, et al. Effects of elevated artificial pneumoperitoneum pressure on invasive blood pressure and levels of blood gases. Braz J Anesthesiol. 2014;64(2):98-104.
• ⁴
  Ozdemır M, Bakan N, Sahın OT, et al. The comparison of sevoflurane-remifentanyl and propofol-remifentanyl in robotic prostatectomies. J Clin Anal Med. 2013;4(4):313-7.
• ⁵
  Talab HF, Zabani IA, Abdelrahman HS, et al. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery. Anesth Analg. 2009;109(5):1511-6.
• ⁶
  Baltieri L, Dos Santos LA, Rasera-Junior I, et al. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation. Braz J Anesthesiol. 2015;65(2):130-5.

Publication Dates

• Publication in this collection
  Jan-Feb 2017