Minerva anestesiologica
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Minerva anestesiologica · May 2012
ReviewAnesthetic concerns for robotic-assisted laparoscopic radical prostatectomy.
The anesthetic concerns of patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) are primarily related to the use of pneumoperitoneum in the steep Trendelenburg position. This combination will affect cerebrovascular, respiratory and hemodynamic homeostasis. ⋯ Close coordination between the anesthesia and surgical teams is required for a successful surgery. This review will discuss the anesthetic concerns and perioperative management of patients presenting for RALP.
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Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. ⋯ This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.