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Endoscopic Extraperitoneal Radical Prostatectomy - part 4

Nếu vấn đề (tức là biến chứng chảy máu) xảy ra trong quá trình hoạt động, áp lực được tăng lên bởi bác sĩ phẫu thuật lên đến 20 mmHg. Điều này nên được áp dụng phối hợp chặt chẽ với bác sĩ gây mê, vì nó luôn gắn liền với khó khăn về hệ thống thông gió cơ khí | 52 Chapter 5 F. Koenig et al. leads to the highest tidal volume is kept constant in order to reduce the pressure difference. In general we aim for tidal volumes of 6-8 ml kg respiration rate of 12-16 min and an inspiratory expiratory I E ratio of 1 1.5. When using this approach the end-expiratory CO2 increase can be maintained within justifiable limits. Only in a few patients with a significant end-tidal CO2 increase 50 mmHg seen only with long operation times is the ventilation frequency initially increased to 24-28 min. Nevertheless in some cases very high end-expiratory CO2 values are achieved which can be more easily tolerated permissive hypercapnia Fig. 5.1 . If problems i.e. bleeding complications occur during the operation the pressure is increased by the surgeon up to 20 mmHg. This should be applied only in close coordination with the anaesthetist since it is always associated with difficulty regarding mechanical ventilation and may last for only a short time 1015 min . 5.8 Postoperative Pain In a recent study by Hoznek et al. the mean dose of morphine and the mean duration of its administration was 53.1 and 44.4 lower respectively after extraperitoneal than after transperitoneal radical prostatectomy. Although the difference was not statistically significant the authors considered it clinically relevant. In addition abdominal tenderness and shoulder pain commonly observed among LRPE patients were not reported in their extraperitoneal series 11 . Our initial experience with minimally invasive treatment of prostate cancer includes 70 cases performed transperitoneally in 2000 and 2001. Due to the lack of experience at that time we postoperatively transferred all patients to the intensive care unit. Administration of analgesia was started intraoperatively with a peripherally acting analgesic metamizole 1-2 g and continued postoperatively using a patient-controlled analgesia PCA pump with piritramide . Later the PCA pumps were omitted due to the fact that .