| Objective:To study the effects and protection of brain function in the the steep Trendelenburg position for robot-assisted surgery in elders. Method:1.review of 20 cases of bladder cancer radical surgery clinical data,10 cases of robotic cystectomy+ full orthotopic ileal neobladder and 10 cases of laparoscopic cystectomy+open ileal neobladder. Compared parameters to explore the risk factors for prolonged postoperative recovery; 2.80 patients undergonging robot-assisted prostatectomy were divided into 2 groups. A elder group (65-80 years, n=40) and a middle-aged group(45-64years,n=40).Pneumoperitoneum before (T0),15min after pneumoperitoneum (T1),15min after Trendelenberg position (T2),60min after Trendelenberg position (T3),Supine position 15 minutes after stopping pneumoperitoneumn(T4) to extract all patients jugular bulb and arterial blood gas analysis. Record above all time points cerebral oxygen saturation (rSO2); jugular bulb oxygen content(SjvO2) jugular bulb pressure(JBP); cerebral arterial and venous oxygen content (Da-jO2); jugular bulb glucose level,(Jglu) and jugular bulb lactic acid level, (Jlac); 3.80 elderly patients who underwent robotic laparoscopic radical prostatectomy were divided into 2 groups:dexmedetomidine group (n=40) and a control group (n=40). Patients in the dexmedetomidine group were given a loading dosage of dexmedetomidine [0.8 μg/(kg·h)] intravenously 10 min before the induction of general anesthesia followed by continuous infusion [0.3 μg/(kg·h)]. Patients in the control group were given 0.9% saline solution instead of dexmedetomidine. After pneumoperitoneum establishment, all patients adopted 40°rendelenberg position.Ramsay score,Riker score,surgery comfort score and VAS scores were measured after operation. Cognitive function was assessed and the concentration of neuron-specific enolase (NSE), rumor necrosis factor-α (TNF-α), superoxide dismutase (SOD) and interleukin-6 (IL-6) were detected at the time of preoperative 1 d, postoperative 1d and 5d.Results:1.The risk factors of logistic analysis showed that:. Ppeak (P= 0.0001), BE (P = 0.0002), PaCO2 (P= 0.005), PetCO2 (P= 0.02),head-down time(P= 0.01), occurred after robotic surgery for delayed awakening; 2.Compared with that at T0,rSO2, SjvO2, JBP were increased significantly at T1,T2, T3 and T4 in both groups (P<0.05); Compared with that of middle-aged group at To, rSO2,SjvO2,JBP were increased significantly and Da-jO2 were decreased at T2, T3in the elder group (P<0.05);3. In the dexmedetomidine group, Riker score was significantly smaller than that of the control group (P<0.05) while Ramsay sedation score was significantly greater than that of the control group (P<0.05). The levels of TNF-a, NSE, and IL-6 in the dexmedetomidine group were significantly reduced compared with those in the control group (P<0.05). The level of SOD in the dexmedetomidine group significantly elevated compared with that in the control group (P<0.05).17 patients in the control group and 11 in the dexmedetomidine group displayed postoperative cognitive dysfunction (POCD) at the 1st day after surgery. Meanwhile,12 patients in the control group and 9 in the dexmedetomidine group showed POCD at the 5th day after surgery (P<0.05).Conclusion:Pneumoperitoneum and Trendelenburg position caused by increased cerebral blood flow and prolong recovery time after operation. Dexmedetomidine could exert a neuroprotective effect on elderly patients in robotic-assisted laparoscopic radical prostatectomy in recovery period of anesthesia and postoperative recovery period, which might be related to the reduction of inflammatory reaction and eliminate oxygen free radicals.by dexmedetomidine. |
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