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Effects of thoracic epidural analgesia combined with general anesthesia on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy

Authors
 Jeong-Yeon Hong  ;  Sung Jin Lee  ;  Koon Ho Rha  ;  Go Un Roh  ;  So Young Kwon  ;  Hae Keum Kil 
Citation
 JOURNAL OF ENDOUROLOGY, Vol.23(11) : 1843-1849, 2009 
Journal Title
 JOURNAL OF ENDOUROLOGY 
ISSN
 0892-7790 
Issue Date
2009
MeSH
Aged ; Analgesia, Epidural/adverse effects* ; Anesthesia, General/adverse effects* ; Blood Gas Analysis ; Demography ; Humans ; Intraoperative Care/adverse effects* ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology* ; Prostatectomy* ; Pulmonary Ventilation/physiology* ; Robotics* ; Thoracic Surgery
Abstract
PURPOSE: The purpose of this study was to evaluate the effects of thoracic epidural analgesia (TEA) on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy requiring high-pressure pneumoperitoneum and the extreme head-down position. METHODS: Seventy-two patients (age range, 58-76 years) scheduled for elective robot-assisted laparoscopic radical prostatectomy were randomly assigned to receive either TEA combined with general anesthesia (TEA group, n = 36) or general anesthesia (GA group, n = 36). T4-sensory block using 1% lidocaine was continuously provided during surgery in the TEA group but not in the GA group. The mode of ventilation was volume controlled with a linear ramp in the pressure wave. Maximum peak inspiratory pressure was preset at 35 mm Hg, and no positive end-expiratory pressure was administered to the patients. Minute ventilation was adjusted to maintain end-tidal CO(2) between 30 and 35 mm Hg by changing respiratory rate during surgery. Intraoperative ventilatory parameters and blood gas analyses were checked. Clinical and radiological pulmonary complications were observed for 3 days postoperatively. RESULTS: Patients in the TEA group showed significantly lower peak inspiratory pressure and higher dynamic compliance with larger expiratory tidal volume during surgery than those in the GA group. They had significantly better oxygenation and lower concentrations of lactate on arterial blood gas analysis than the GA group. Postoperative clinical and radiological complication rates were not significantly different. CONCLUSIONS: TEA combined with general anesthesia improved intraoperative ventilation/oxygenation. Although clinical and radiologic pulmonary complications were not significantly influenced, TEA can be considered an option for patients with limited reserve capacity or preexisting impairments of visceral blood flow.
Full Text
http://online.liebertpub.com/doi/abs/10.1089/end.2009.0059
DOI
10.1089/end.2009.0059
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwon, So Young(권소영)
Kil, Hae Keum(길혜금)
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Lee, Sung Jin(이성진)
Hong, Jeong Yeon(홍정연)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/105362
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