Abstract
Amaç: Robotik yardımlı laparoskopik cerrahi geçiren hastalar, artmış postoperatif bulantı ve kusma (PONV) riski altındadır. Bu çalışma, robotik cerrahide intraoperatif end-tidal karbondioksit (ETCO₂) düzeylerinin PONV insidansı üzerindeki etkisini araştırmayı amaçladı.
Yöntemler: Bu gözlemsel klinik çalışmaya, robotik yardımlı laparoskopik radikal prostatektomi uygulanan hastalar dahil edildi. Hastalar, intraoperatif ETCO₂ düzeylerine göre iki gruba ayrıldı: Grup 1 (26–35 mmHg) ve Grup 2 (36–45 mmHg). PONV insidansı, kurtarıcı antiemetik kullanımı ve ağrı skorları postoperatif 0, 2, 4, 8, 12 ve 24. saatlerde kaydedildi.
Bulgular: Grup 1, postoperatif 0. saatte (p < 0.001) ve 2. saatte (p = 0.046) anlamlı olarak daha düşük Apfel skorlarına sahipti. Ayrıca, Grup 2'de ilk 24 saat içinde daha yüksek PONV insidansı ve artmış kurtarıcı antiemetik kullanımı gözlendi (p < 0.05).
Sonuç: Düşük intraoperatif ETCO₂ düzeyleri, PONV riski yüksek olan robotik yardımlı laparoskopik cerrahilerde PONV insidansının azalmasıyla ilişkilendirildi. PONV, hasta konforunu ve iyileşmesini olumsuz etkileyen önemli bir klinik sorundur. Gelecekteki araştırmaların, PONV'nin önlenmesine yönelik farmakolojik ve farmakolojik olmayan stratejileri araştırmaya devam etmesi gerektiğine inanıyoruz.
Keywords
End-tidal karbondioksit Ağrı Postoperatif bulantı ve kusma Robotik yardımlı laparoskopik radikal prostatektomi
References
- 1. Trinh Q-D, Sammon J, Sun M, et al. Perioperative Outcomes of Robot-Assisted Radical Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample. European Urology. 2012;61(4):679-85.
- 2. Bivalacqua TJ, Pierorazio PM, Su LM. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach. Surg Oncol. 2009;18(3):233-41.
- 3. Kishikawa H, Suzuki N, Suzuki Y, et al. Effect of Robot-assisted Surgery on Anesthetic and Perioperative Management for Minimally Invasive Radical Prostatectomy under Combined General and Epidural Anesthesia. J Nippon Med Sch. 2021;88(2):121-7.
- 4. Aceto P, Beretta L, Cariello C, et al. Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU. Minerva Anestesiol. 2019;85(8):871-85.
- 5. Irvine M, Patil V. Anaesthesia for robot-assisted laparoscopic surgery. Continuing Education in Anaesthesia Critical Care & Pain. 2009;9(4):125-9.
- 6. Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742-53.
- 7. Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract. 2011;2011:748031.
- 8. Teramoto Y, Urano T, Nagai N, et al. Plasma levels of 5-HT and 5-HIAA increased after intestinal ischemia/reperfusion in rats. Jpn J Physiol. 1998;48(5):333-9.
- 9. Besir A, Tugcugil E. Comparison of different end-tidal carbon dioxide levels in preventing postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery. Journal of Obstetrics and Gynaecology. 2021;41(5):755-62.
- 10. Fujimoto D, Egi M, Makino S, et al. The association of intraoperative end-tidal carbon dioxide with the risk of postoperative nausea and vomiting. J Anesth. 2020;34(2):195-201.
- 11. Boogaerts JG, Vanacker E, Seidel L, et al. Assessment of postoperative nausea using a visual analogue scale. Acta Anaesthesiol Scand 2000;44:470–4.
- 12. Son JS, Oh JY, Ko S. Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: a double-blind randomized controlled study. Surg Endosc. 2017;31(11):4576-82.
- 13. Feng WJ, Zhao BC, Yang H, et al. Effects of intra-operative end-tidal carbon dioxide levels on postoperative nausea and vomiting after thyroidectomy: A pilot randomised controlled study. Eur J Anaesthesiol. 2022;39(4):399-401.
- 14. Yilmaz G, Akca A, Kiyak H, et al. Elevation in optic nerve sheath diameter due to the pneumoperitoneum and Trendelenburg is associated to postoperative nausea, vomiting and headache in patients undergoing laparoscopic hysterectomy. Minerva Anestesiol. 2020;86(3):270-6.
- 15. Saghaei M, Matin G, Golparvar M. Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial. Adv Biomed Res. 2014;3:84.
- 16. Rosenthal RJ, Friedman RL, Kahn AM, et al. Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model. J Gastrointest Surg. 1998;2(5):415-25.
- 17. Hariri RJ, Firlick AD, Shepard SR, et al. Traumatic brain injury, hemorrhagic shock, and fluid resuscitation: effects on intracranial pressure and brain compliance. J Neurosurg. 1993;79(3):421-7.
- 18. Luz CM, Polarz H, Böhrer H, et al. Hemodynamic and respiratory effects of pneumoperitoneum and PEEP during laparoscopic pelvic lymphadenectomy in dogs. Surg Endosc. 1994;8(1):25-7.
- 19. Guo W, Ding J, Jin X, et al. Effect of cerebral oxygen saturation on postoperative nausea and vomiting in female laparoscopic surgery patients. Medicine (Baltimore). 2017;96(41):e8275.
Abstract
Aim: Patients undergoing robotic-assisted laparoscopic procedures tend to experience a higher frequency of postoperative nausea and vomiting (PONV). This study aimed explore the influence of intraoperative end-tidal carbon dioxide (ETCO₂) levels on the occurrence of PONV in robotic surgery.
Methods: This observational clinical study included patients undergoing robotic laparoscopic radical prostatectomy. Patients were divided into two groups based on intraoperative ETCO₂ levels: Group 1 (26–35 mmHg) and Group 2 (36–45 mmHg). The incidence of PONV, the use of rescue antiemetics, and pain scores were recorded at 0, 2, 4, 8, 12, and 24 hours postoperatively.
Results: We found that Group 1 exhibited lower Apfel scores at both 0 (p < 0.001) and 2 (p = 0.046) hours post-surgery. Furthermore, Group 2 had a higher incidence of PONV and greater usage of rescue antiemetics within the first 24 hours following surgery. (p<0.05)
Conclusion: We found that lower intraoperative ETCO₂ levels were associated with a reduced incidence of PONV in robotic laparoscopic surgery, a procedure known to carry a high risk of PONV.PONV remains a significant clinical issue that negatively affects patient comfort and recovery. we believe that future research should continue to explore the effectiveness of both pharmacological and non-pharmacological approaches for the prevention of PONV.
Keywords
End-tidal carbon dioxide Pain Postoperative nausea and vomiting Robotic-assisted laparoscopic radical prostatectomy
References
- 1. Trinh Q-D, Sammon J, Sun M, et al. Perioperative Outcomes of Robot-Assisted Radical Prostatectomy Compared With Open Radical Prostatectomy: Results From the Nationwide Inpatient Sample. European Urology. 2012;61(4):679-85.
- 2. Bivalacqua TJ, Pierorazio PM, Su LM. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach. Surg Oncol. 2009;18(3):233-41.
- 3. Kishikawa H, Suzuki N, Suzuki Y, et al. Effect of Robot-assisted Surgery on Anesthetic and Perioperative Management for Minimally Invasive Radical Prostatectomy under Combined General and Epidural Anesthesia. J Nippon Med Sch. 2021;88(2):121-7.
- 4. Aceto P, Beretta L, Cariello C, et al. Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU. Minerva Anestesiol. 2019;85(8):871-85.
- 5. Irvine M, Patil V. Anaesthesia for robot-assisted laparoscopic surgery. Continuing Education in Anaesthesia Critical Care & Pain. 2009;9(4):125-9.
- 6. Apfel CC, Heidrich FM, Jukar-Rao S, et al. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anaesth. 2012;109(5):742-53.
- 7. Chatterjee S, Rudra A, Sengupta S. Current concepts in the management of postoperative nausea and vomiting. Anesthesiol Res Pract. 2011;2011:748031.
- 8. Teramoto Y, Urano T, Nagai N, et al. Plasma levels of 5-HT and 5-HIAA increased after intestinal ischemia/reperfusion in rats. Jpn J Physiol. 1998;48(5):333-9.
- 9. Besir A, Tugcugil E. Comparison of different end-tidal carbon dioxide levels in preventing postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery. Journal of Obstetrics and Gynaecology. 2021;41(5):755-62.
- 10. Fujimoto D, Egi M, Makino S, et al. The association of intraoperative end-tidal carbon dioxide with the risk of postoperative nausea and vomiting. J Anesth. 2020;34(2):195-201.
- 11. Boogaerts JG, Vanacker E, Seidel L, et al. Assessment of postoperative nausea using a visual analogue scale. Acta Anaesthesiol Scand 2000;44:470–4.
- 12. Son JS, Oh JY, Ko S. Effects of hypercapnia on postoperative nausea and vomiting after laparoscopic surgery: a double-blind randomized controlled study. Surg Endosc. 2017;31(11):4576-82.
- 13. Feng WJ, Zhao BC, Yang H, et al. Effects of intra-operative end-tidal carbon dioxide levels on postoperative nausea and vomiting after thyroidectomy: A pilot randomised controlled study. Eur J Anaesthesiol. 2022;39(4):399-401.
- 14. Yilmaz G, Akca A, Kiyak H, et al. Elevation in optic nerve sheath diameter due to the pneumoperitoneum and Trendelenburg is associated to postoperative nausea, vomiting and headache in patients undergoing laparoscopic hysterectomy. Minerva Anestesiol. 2020;86(3):270-6.
- 15. Saghaei M, Matin G, Golparvar M. Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial. Adv Biomed Res. 2014;3:84.
- 16. Rosenthal RJ, Friedman RL, Kahn AM, et al. Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model. J Gastrointest Surg. 1998;2(5):415-25.
- 17. Hariri RJ, Firlick AD, Shepard SR, et al. Traumatic brain injury, hemorrhagic shock, and fluid resuscitation: effects on intracranial pressure and brain compliance. J Neurosurg. 1993;79(3):421-7.
- 18. Luz CM, Polarz H, Böhrer H, et al. Hemodynamic and respiratory effects of pneumoperitoneum and PEEP during laparoscopic pelvic lymphadenectomy in dogs. Surg Endosc. 1994;8(1):25-7.
- 19. Guo W, Ding J, Jin X, et al. Effect of cerebral oxygen saturation on postoperative nausea and vomiting in female laparoscopic surgery patients. Medicine (Baltimore). 2017;96(41):e8275.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Articles |
| Authors | |
| Publication Date | June 30, 2025 |
| Submission Date | May 2, 2025 |
| Acceptance Date | June 9, 2025 |
| Published in Issue | Year 2025 Volume: 8 Issue: 2 |
