Anästhesie in der Urologie – Anästhesie bei roboterassistierter Prostatektomie

Zusammenfassung

Roboterassistierte Prostatektomien haben durch die guten operativen Ergebnisse, die ausgezeichneten operativen Bedingungen und den hohen postoperativen Patientenkomfort eine sehr schnell zunehmende Verbreitung gefunden. Durch die Kombination von CO₂-Insufflation und extremer Lagerung entstehen während roboterassistierten Prostatektomien moderate hämodynamische und pulmonale Nebenwirkungen. Außerdem kann es zu Ödembildung im Kopf-Hals-Bereich, zum Anstieg des Augeninnendrucks und zur Entwicklung eines Kompartmentsyndroms in den Beinen kommen. Es besteht keine Einschränkung in der Auswahl der Anästhetika. Die Vorbereitung der Patienten, angepasstes Monitoring und biphasisches Volumenmanagement tragen zu den guten Ergebnissen bei.

Abstract

Because of excellent results, high patient satisfaction, and extraordinary surgical conditions robotic assisted prostatectomies have found a wide spread acceptance. Trendelenburg positioning, CO₂-Insufflation, and installation of the robot system cause moderate hemodynamic and respiratory changes. Respiration can be compromised by significantly reduced pulmonary compliance during surgery and a marked CO₂ load. Therefore, arterial blood gas controls during surgery can be recommended. Over hours edema of head and neck including the upper airways and an increase of the intraocular pressure can develop. There are no restrictions in the choice of the anesthetics. Careful positioning of the patient and critical intravenous fluid management are important determinants of a successful anesthetic management.

Schlüsselwörter:

Da Vinci radikale Prostatektomie - anästhesiologisches Management - Lagerung - Komplikationen

Keywords:

robotic surgery - Trendelenburg position - glaucoma - compartment syndrome

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