TY - JOUR
T1 - Effects of Pneumoperitoneum and the Steep Trendelenburg Position on Heart Rate Variability and Cerebral Oxygenation during Robotic Sacrocolpopexy
AU - Matanes, Emad
AU - Weissman, Amir
AU - Rivlin, Aleksandr
AU - Lauterbach, Roy
AU - Amit, Amnon
AU - Wiener, Zeev
AU - Lowenstein, Lior
N1 - Publisher Copyright:
© 2017 American Association of Gynecologic Laparoscopists
PY - 2018/1
Y1 - 2018/1
N2 - Study Objective The aim of this study was to investigate how steep Trendelenburg positioning with pneumoperitoneum modifies brain oxygenation and autonomic nervous system modulation of heart rate variability during robotic sacrocolpopexy. Design Prospective study (Canadian Task Force classification III). Setting Rambam Health Care Campus. Patients Eighteen women who underwent robotic sacrocolpopexy for treatment of uterovaginal or vaginal apical prolapse. Interventions Robotic sacrocolpopexy. Measurements and Main Results A 5-minute computerized electrocardiogram, cerebral O 2 saturation (cSO 2 ), systemic O 2 saturation, heart rate (HR), diastolic blood pressure (BP), systolic BP, and end-tidal CO 2 tension were recorded immediately after anesthesia induction (baseline phase) and after alterations in positioning and in intra-abdominal pressure. HR variability was assessed in time and frequency domains. Cerebral oxygenation was measured by the technology of near-infrared spectrometry. cSO 2 at baseline was 73% ± 9%, with minor and insignificant elevation during the operation. Mean HR decreased significantly when the steep Trendelenburg position was implemented (66 ± 10 vs 55 ± 9 bpm, p <.05) and returned gradually to baseline with advancement of the operation and the decrease in intra-abdominal pressure. Concomitant with this decrease, the power of both arms of the autonomic nervous system increased significantly (2.8 ±.8 vs 3.3 ±.9 ms 2 /Hz and 2.5 ± 1.2 vs 3.2 ±.9 ms 2 /Hz, respectively, p <.05). All these effects occurred without any significant shifts in systolic or diastolic BP or in systemic or cerebral oxygenation. Conclusion This study supports the safety of robotic sacrocolpopexy performed with steep Trendelenburg positioning with pneumoperitoneum. Only minor alterations were observed in cerebral oxygenation and autonomic perturbations, which did not cause clinically significant alterations in HR rate and HR variability.
AB - Study Objective The aim of this study was to investigate how steep Trendelenburg positioning with pneumoperitoneum modifies brain oxygenation and autonomic nervous system modulation of heart rate variability during robotic sacrocolpopexy. Design Prospective study (Canadian Task Force classification III). Setting Rambam Health Care Campus. Patients Eighteen women who underwent robotic sacrocolpopexy for treatment of uterovaginal or vaginal apical prolapse. Interventions Robotic sacrocolpopexy. Measurements and Main Results A 5-minute computerized electrocardiogram, cerebral O 2 saturation (cSO 2 ), systemic O 2 saturation, heart rate (HR), diastolic blood pressure (BP), systolic BP, and end-tidal CO 2 tension were recorded immediately after anesthesia induction (baseline phase) and after alterations in positioning and in intra-abdominal pressure. HR variability was assessed in time and frequency domains. Cerebral oxygenation was measured by the technology of near-infrared spectrometry. cSO 2 at baseline was 73% ± 9%, with minor and insignificant elevation during the operation. Mean HR decreased significantly when the steep Trendelenburg position was implemented (66 ± 10 vs 55 ± 9 bpm, p <.05) and returned gradually to baseline with advancement of the operation and the decrease in intra-abdominal pressure. Concomitant with this decrease, the power of both arms of the autonomic nervous system increased significantly (2.8 ±.8 vs 3.3 ±.9 ms 2 /Hz and 2.5 ± 1.2 vs 3.2 ±.9 ms 2 /Hz, respectively, p <.05). All these effects occurred without any significant shifts in systolic or diastolic BP or in systemic or cerebral oxygenation. Conclusion This study supports the safety of robotic sacrocolpopexy performed with steep Trendelenburg positioning with pneumoperitoneum. Only minor alterations were observed in cerebral oxygenation and autonomic perturbations, which did not cause clinically significant alterations in HR rate and HR variability.
KW - Cerebral oxygenation
KW - Heart rate variability
KW - Laparoscopy
KW - Minimally invasive
KW - Robotic surgery
KW - Sacrocolpopexy
UR - http://www.scopus.com/inward/record.url?scp=85028046168&partnerID=8YFLogxK
U2 - 10.1016/j.jmig.2017.07.009
DO - 10.1016/j.jmig.2017.07.009
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C2 - 28734974
AN - SCOPUS:85028046168
SN - 1553-4650
VL - 25
SP - 70
EP - 75
JO - Journal of Minimally Invasive Gynecology
JF - Journal of Minimally Invasive Gynecology
IS - 1
ER -