Effects of Steep Trendelenburg and Pneumoperitoneum on Cardiac Performance During Robotic-assisted Surgery in Patients With Normal and Low Ejection Fraction

What this Trial Is About

Robotic-assisted laparoscopic surgery is increasingly used, especially for older and more fragile patients who may not tolerate major open surgery. This research focuses on the challenges to heart function during robotic surgery involving a steep 30-degree head-down tilt (Trendelenburg position), which can increase the heart's workload. The study compares patients with normal heart function to those with systolic heart failure under these conditions to understand circulatory effects better. Participants undergo preoperative echocardiography to classify heart function as normal or decreased (ejection fraction 45% or lower). During surgery, heart performance is monitored using an esophageal doppler device, while brain oxygen levels are measured by optical spectrophotometry. Measurements are taken before anesthesia, during Trendelenburg positioning, at the start of the pneumoperitoneum (carbon dioxide insufflation), and after returning to a flat position. Throughout the study, standard anesthesia parameters and various cardiac output measures are recorded to analyze heart workload changes. The main outcome is the change in stroke volume during Trendelenburg positioning and pneumoperitoneum within 15 minutes. Secondary outcomes include changes in systemic vascular resistance, pulse pressure variation, peak velocity, stroke volume variation, flow time corrected, and regional brain oxygen saturation. This observational study helps identify which patients may be at risk of heart complications during robotic surgery and informs safer surgical decisions.

Cardiac Performance During Steep Trendelenburg Position in Patients Undergoing Robotic Surgery Surgery.