Laparoscopy Clinical Trial
Official title:
Cardiovascular Effects of the Degree of Head-down and Pneumoperitoneum During Laparoscopy
The aim of this study is to observe the cardiovascular effects of the degree of head-down angle and pneumoperitoneum during laparoscopic procedure using by the fourth version Vigileo-Flotrac system.
Laparoscopy for general surgery followed and proved to be advantageous in reduction of
postoperative pain, better cosmetic results, quicker return to normal activities, reduction
in hospital stay resulting in overall reduction in medical cost, less intraoperative
bleeding, less postoperative pulmonary complications, less postoperative wound infection,
reduced metabolic derangement, and better postoperative respiratory function. In recent
years, advanced laparoscopic surgery has targeted older and sicker patients, rendering
anesthesia during laparoscopy more technically demanding. Robotic-assisted laparoscopic
radical prostatectomy is rapidly becoming a part of the standard surgical repertoire for the
treatment of prostate cancer. Robotic-assisted laparoscopic radical prostatectomy are
primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This
combination will affect cerebrovascular, respiratory and hemodynamic homeostasis. The golden
standard method for measuring cardiac output in the clinical setting is thermodilution using
a pulmonary artery catheter, but the risk of pulmonary artery catheter insertion can not be
justified in routine cases. The Vigileo-FloTrac system (Edwards Lifesciences, Irvine, CA,
USA), is a less invasive method to obtain continuous CO using pulse contour analysis. The
aim of this study is to observe the cardiovascular effects of the degree of head-down angle
and pneumoperitoneum during laparoscopic procedure using by the fourth version
Vigileo-Flotrac system.
We choose 180 ASA physical status I to III patients undergoing laparoscopic surgery are
enrolled in this study. These surgical procedures include laparoscopic cholecystectomy,
laparoscopic gastrectomy, laparoscopic colectomy, laparoscopic appendectomy, laparoscopic
assisted vaginal hysterectomy, robot-assisted laparoscopic radical prostatectomy. These
surgical procedures provide the information about the different degree of head-down angle
and different intra-abdominal pressure of pneumoperitoneum. Hemodynamic data are recorded
immediately after induction of anesthesia; 5 min after induction of pneumoperitoneum; 5, 15,
30, 60 min, and every 30 min if duration more than 60 min after placement in the
Trendelenburg position with pneumoperitoneum; and the end.
After observing the cardiovascular effects of degree of head-down, insufflation pressure,
duration of surgery, we can prevent the possible complications in advance during
laparoscopic surgery. After completing the study, we will be familiar with the use of
Vigileo-FloTrac system. We will have more experiences to deal with high-risk patients
undergoing simple surgical procedure.
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Observational Model: Cohort, Time Perspective: Prospective
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