Effect of Optimized PEEP on Mechanical Ventilation During Robot Assisted Laparoscopic Prostatectomy

Gangnam Severance Hospital42 enrolled

Overview

Steep trendelenburg posture or pneumoperitoneum for surgery causes ventilation problems during surgery, so finding a way to overcome is a challenging task for anesthesiologists. In this study, for patients undergoing robot assisted laparoscopic prostatectomy under general anesthesia, anesthesia is going to perform by applying conventional positive end-expiratory pressure (PEEP 5cmH2O) or individually determined positive end-expiratory pressure values for each patient using electrical impedance tomography. We plan to compare intraoperative ventilation through arterial blood gas analysis to find out the way to improve intraoperative ventilation.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

DOUBLE

Enrollment

Conditions

Prostate Cancer

Interventions

optimized PEEPDEVICE

Immediately after induction of anesthesia, the patient remains unapplied to PEEP. After pneumoperitoneum + Trendelenburg posture, an appropriate PEEP value is derived using electrical impedance tomography (airtom®). And then derived value ( = optimized PEEP value) is applied until the end of the operation.

Eligibility

Sex: MALEMin age: 20 YearsMax age: 70 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. 20 - 70 years of age who are scheduled for robotic assisted laparoscopic prostatectomy at the Department of Urology, Gangnam Severance Hospital, 2. ASA-PS (American Society of Anesthesiology Body Rating) I-IlI, 3. Patients with a BMI of 35 kg/m2 or less Exclusion Criteria: 1. Patients with lung disease 2. BMI \>35kg/m2 3. Patients for whom positive end-tidal pressure cannot be applied (large bullae, severe cardiac disease) 4. patient refusal

Outcomes

Primary Outcomes

PaO2/FiO2

PaO2/FiO2 is the ratio of arterial oxygen partial pressure (PaO2) to oxygen fraction (FiO2), and is a commonly used indicator for evaluating pulmonary ventilation and diagnosing lung damage. Using this index, it is possible to determine whether oxygen obtained through the lungs is well delivered to the blood or not. It can be easily obtained by arterial blood gas analysis without complicated formulas or graphs.

Time frame: end of surgery (before extubation)

Secondary Outcomes

PaO2/FiO2

partial pressure (PaO2) to oxygen fraction (FiO2), and is a commonly used indicator for evaluating pulmonary ventilation and diagnosing lung damage. Using this index, it is possible to determine whether oxygen obtained through the lungs is well delivered to the blood or not. It can be easily obtained by arterial blood gas analysis without complicated formulas or graphs.

Time frame: 15 minutes after intubation, 1 hour after pnemoperitoneum

ROI (region of interests)

region of interest using EIT

Time frame: 15 minutes after intubation, 1 hour after pnemoperitoneum, end of surgery (before extubation)

inhomogeneity index

inhomogeneity index : this index calculated from tidal EIT images representing the difference in impedance between the end of inspiration and the end of expiration.

Time frame: 15 minutes after intubation, 1 hour after pnemoperitoneum, end of surgery (before extubation)

total amount of fluid administered during surgery

Time frame: end or surgery

total dose of vasopressor administered during surgery

Time frame: end of surgery

length of hospitalization after surgery

Time frame: 1 month after surgery