Year : 2008  |  Volume : 2  |  Issue : 2  |  Page : 62-66

Five hours of insufflation in a bad position: Anaesthetic implications

1 Department of Anesthesia, Faculty of Medicine , Mansoura University, Mansoura, Egypt
2 Department of Urology, Faculty of Medicine , Mansoura University, Mansoura, Egypt

Correspondence Address:
A A Shorrab
Department of Anesthesia, Faculty of Medicine , Mansoura University, Mansoura
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Source of Support: None, Conflict of Interest: None

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Background. Laparoscopic radical cystectomy is a relatively new surgical procedure. Being a procedure of long duration, performed with pneumoperitoneum in exaggerated Trendlenberg position; it is expectedtopose unfavorable effects. We report pulmonary and haemodynamic changes in addition to postoperative outcome following laparoscopic radical cystectomy. Patients and Methods. The study was conducted on 31 patients anaesthetized with a combination of epidural and total intravenous anaesthesia (using midazolam, fentanyl, ketamine and vecuronium). Surgery wasdone while the patient in head down position (40 o ). Lungs were ventilated using air-oxygen (FiO2 = 0.35) with a tidal volume of 8 ml kg -1 at a rate of 12-14 min -1 . Lung mechanics and hemodynamic variables were recorded at different strategic points. Recovery and postoperative outcome were also evaluated. Results. Two patients were excluded due to conversion to open surgery and 29 completed the procedure. Fourteen of 29 patients (48.2%) had preoperative medical diseases and 11 patients (38%) received blood. There were significant decrease in lung compliance and significant increase in peak pressures after pneumoperitoneum and Trendlenberg position. Concomitantly, heart rate, arterial pressure and carbondioxide tension increased significantly. Three patients suffered post-extubation airway obstruction and the trachea was re-intubated. On the first postoperative day, one patient desaturated and one patient suffered severe nausea and vomiting. Conclusions. Laparoscopic radical cystectomy in exaggerated head down position may be associated with harmful consequences and potential risks.

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