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Journal of Clinical Monitoring and Computing

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Open Access 01-08-2021 | Prostatectomy | Original Research

Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study

Authors: Stefanie Beck, Haissam Ragab, Dennis Hoop, Aurélie Meßner-Schmitt, Cornelius Rademacher, Ursula Kahl, Franziska von Breunig, Alexander Haese, Markus Graefen, Christian Zöllner, Marlene Fischer

Published in: Journal of Clinical Monitoring and Computing | Issue 4/2021

Abstract

Purpose

Surgery in the prolonged extreme Trendelenburg position may lead to elevated intracranial pressure and compromise cerebral hemodynamic regulation. We hypothesized that robot-assisted radical prostatectomy with head-down tilt causes impairment of cerebral autoregulation compared with open retropubic radical prostatectomy in the supine position.

Methods

Patients scheduled for elective radical prostatectomy were included at a tertiary care prostate cancer clinic. Continuous monitoring of the cerebral autoregulation was performed using the correlation method. Based on measurements of cerebral oxygenation with near-infrared spectroscopy and invasive mean arterial blood pressure (MAP), a moving correlation coefficient was calculated to obtain the cerebral oxygenation index as an indicator of cerebral autoregulation. Cerebral autoregulation was measured continuously from induction until recovery from anesthesia.

Results

There was no significant difference in cerebral autoregulation between robot-assisted and open retropubic radical prostatectomy during induction (p = 0.089), intraoperatively (p = 0.162), and during recovery from anesthesia (p = 0.620). Age (B = 0.311 [95% CI 0.039; 0.583], p = 0.025) and a higher difference between baseline MAP and intraoperative MAP (B = 0.200 [95% CI 0.073; 0.327], p = 0.002) were associated with impaired cerebral autoregulation, whereas surgical technique was not (B = 3.339 [95% CI 1.275; 7.952], p = 0.155).

Conclusion

Compared with open radical prostatectomy in the supine position, robot-assisted surgery in the extreme Trendelenburg position with capnoperitoneum did not lead to an impairment of cerebral autoregulation during the perioperative period in our study population.

Trial registration number: DRKS00010014, date of registration: 21.03.2016, retrospectively registered.

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Title: Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study
Authors: Stefanie Beck
Haissam Ragab
Dennis Hoop
Aurélie Meßner-Schmitt
Cornelius Rademacher
Ursula Kahl
Franziska von Breunig
Alexander Haese
Markus Graefen
Christian Zöllner
Marlene Fischer
Publication date: 01-08-2021
Publisher: Springer Netherlands
Keywords: Prostatectomy
Prostatectomy
Published in: Journal of Clinical Monitoring and Computing / Issue 4/2021
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-020-00549-0

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Comparing the effect of positioning on cerebral autoregulation during radical prostatectomy: a prospective observational study

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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