Nurdan BEDİRLİ, Mehmet AKÇABAY, Fusun BOZKIRLI

Effects of steep Trendelenburg position and pneumoperitoneum on middle ear pressure in patients undergoing robotic radical prostatectomy

Background/aim: The aim of this study was to quantify the changes in middle ear pressure (MEP) during robot-assisted radical prostatectomy (RARP). Materials and methods: Thirty patients undergoing RARP were included in this study. MEP was obtained at the following time points: awake (T1), postintubation (T2), pneumoperitoneum + 1 h of Trendelenburg position (T3), pneumoperitoneum + 2 h of Trendelenburg position (T4), pneumoperitoneum + 3 h of Trendelenburg position (T5), desufflation + supine position (T6), and 1 h after extubation in the postanesthesia care unit (T7). Heart rate, mean arterial pressure (MAP), peak airway pressure (PAP), tidal volume, minute ventilation, EtCO2 , and blood gas values were recorded. Results: MEP was significantly higher at T4, T5, T6, and T7 as compared to T1 values. PAP values were significantly increased at T3, T4, and T5 compared to T2. MAP values at T3, T4, and T5 were significantly higher compared to T1. PaCO2increased significantly at T4, T5, and T6 and pH decreased significantly at T4 and T5 when compared to T2. Conclusion: The combination of steep Trendelenburg position and pneumoperitoneum during RARP caused a significant increase in MEP, PaCO2 , and EtCO2levels. This propensity for increased MEP may cause problems in patients with preexisting ear disease.

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1. Trinh QD, Sammon J, Sun M, Ravi P, Ghani KR, Bianchi M, Jeong W, Shariat SF, Hansen J, Schmitges J et al. Perioperative outcomes of robot-assisted radical prostatectomy compared with open radical prostatectomy results from the nationwide inpatient sample. Eur Urol 2012; 61: 679-685. 2. Novara G, Ficarra V, Rosen RC, Artibani W, Costello A, Eastham JA, Graefen M, Guazzoni G, Shariat SF, Stolzenburg JU et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012; 62: 431-452. 3. Hu JC, Gu X, Lipsitz SR, Barry MJ, DAmico AV, Weinberg AC, Keating NL. Comparative effectiveness of minimally invasive vs open radical prostatectomy. J Am Med Assoc 2009; 302: 1557-1564. 4. Kadono Y, Yaegashi H, Machioka K, Ueno S, Miwa S, Maeda Y, Miyagi T, Mizokami A, Fujii Y, Tsubokawa T et al. Cardiovascular and respiratory effects of the degree of head-down angle during robot-assisted laparoscopic radical prostatectomy. Int J Med Robot. 2013; 9: 17-22. 5. Kalmar AF, Foubert L, Hendrickx JF, Mottrie A, Absalom A, Mortier EP, Struys MM. Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth 2010; 104: 433-439. 6. Kilic OF, Börgers A, Köhne W, Musch M, Kröpft D, Groeben H. Effects of steep Trendelenburg position for robotic-assisted prostatectomies on intra-and extrathoracic airways in patients with or without chronic obstructive pulmonary disease. Br J Anaesth 2015; 114: 70-76. 7. Lee JR. Anesthetic consideration for robotic surgery. Korean J Anesthesiol 2014; 66: 3-11. 8. Falabella A, Moore-Jeffries E, Sullivan MJ, Nelson R, Lew M. Cardiac function during steep Trendelenburg position and CO2 pneumoperitoneum for robotic-assisted prostatectomy: a trans-oesophageal Doppler probe study. Int J Med Robot 2007; 3: 312-315. 9. Tideholm B, Carlborg B, Jonsson S, Bylander-Groth A. Continuous long-term measurements of the middle ear pressure in subjects without a history of ear disease. Acta Otolaryngol 1998; 118: 369-374. 10. Patterson ME, Bartlett PC. Hearing impairment caused by intratympanic pressure changes during general anesthesia. Laryngoscope 1976; 86: 399-404. 11. Guler S, Apan A, Muluk NB, Budak B, Oz G, Kose E. A. Sevoflurane vs. TIVA in terms of middle ear pressure during laparoscopic surgery. Adv Clin Exp Med 2014; 23: 447-454. 12. Karabiyik L, Bozkirli F, Çelebi H, Goksu N. Effects of nitrous oxide on middle ear pressure: a comparison between inhalation anesthesia with nitrous oxide and TIVA. Eur J Anaesthesiol 1996; 13: 27-32. 13. Cinamon U, Russo E, Levy D. Middle ear pressure changes as function of body position. Laryngoscope 2009; 119: 347-350. 14. Degerli D, Acar B, Sahap M, Horasanlı E. Effect of laryngoscopy on middle ear pressure during anaesthesia induction. Int J Clin Exp Med 2013; 6: 809-813. 15. Award H, Santili S, Ohr M, Roth A, Yan W, Fernandez S, Roth S, Patel V. The effects of steep Trendelenburg position on intraocular pressure during robotic radical prostatectomy. Anesth Analg 2009; 109: 473-478. 16. Akiyama N, Fukuda TY, Takahashi H. Influence of continuous negative pressure in the rat middle ear. Laryngoscope 2014; 124: 2404-2410. 17. Thom JJ, Carlson ML, Driscoll LW, Louis EK, Ramar K, Olson EJ, Neff BA. Middle ear pressure during sleep and the effects of continuous positive airway pressure. Am J Otolaryngol. 2015; 36: 173-177. 18. Ozturk O, Demiraran Y, Ilce E, Guclu E, Karaman E. Effects of sevoflurane and TIVA with propofol on middle ear pressure. Int J Ped Otorhinolaryngol 2006; 70: 1231-1234. 19. Ozturk O, Ilce Z, Demiraran Y, Iskender A, Guclu E, Yildizbas S. Effects of desflurane on middle ear pressure. Int J Ped Otorhinolaryngol 2007; 71: 1439-1441. 20. Nader ND, Simpson G, Reedy RL. Middle ear pressure changes after nitrous oxide anesthesia and its effect on postoperative nausea and vomiting. Laryngoscope 2004; 114: 883-886. 21. Perreault L, Normandin N, Plamondon L, Blain R, Rousseau P, Girard M, Forget G. Tympanic membrane rupture after anesthesia with nitrous oxide. Anesthesiology 1982; 57: 325- 326. 22. Garcia Callejo FJ, Velert Vila MM. Facial paralysis after nonotologic surgery under general anesthesia. Acta Otorrinolaringol Esp 1998; 49: 173-175.