Effect of Body Mass on Oxygenation and Intra-Abdominal Pressure When Using a Jackson Surgical Table in the Prone Position During Lumbar Surgery.

STUDY DESIGN: Prospective observational study. OBJECTIVE: To test the hypothesis that different types of surgical frame and the patient's body mass index (BMI) can affect pulmonary compliance, intra-abdominal pressure (IAP), and oxygenation. SUMMARY OF BACKGROUND DATA: The oxygenation index (PaO2/FiO2) and IAP are known to be associated with BMI when patients are in the supine position. However, there are few reports on the correlation between BMI, the oxygenation index, and IAP in the prone position, especially when a Jackson surgical table is used. METHODS: Thirty-seven adult patients were divided into two groups according to BMI: normal-weight patients (n = 19, BMI: 18.5-24.9 kg m) and overweight patients (n = 18, BMI ≥ 25 kg m). After the induction of general anesthesia, patients were turned to the prone position onto either a Jackson surgical table (Mizuho OSI) or a general surgical table (MAQUET; foam pad, China). The patient's IAP, peak airway pressure, pulmonary dynamic compliance (Cdyn), and oxygenation index were recorded. RESULTS: In overweight patients, there was a greater increase in peak airway pressure and a greater decrease in Cdyn observed when a general surgical table was used compared with the Jackson surgical table. When the Jackson surgical table was used, there was a greater increase in the oxygenation index and a greater decrease in IAP. There was a significant negative correlation between the oxygenation index and BMI and a significant positive correlation between IAP and BMI in the prone position. CONCLUSION: Turning patients from the supine to the prone position during anesthesia results in an increase in the oxygenation index and a decrease in IAP. Both of these factors are dependent upon the type of surgical frame used and the patient's BMI. The reduction in IAP was particularly significant when a Jackson surgical table was used for overweight patients. LEVEL OF EVIDENCE: 4.

[Anesthesia management of laparoscopic radical cystectomy and orthotopic bladder surgery with a robotic-assisted surgical system].

OBJECTIVE: To summarize anesthesia management of laparoscopic radical cystectomy and orthotopic bladder surgery with a robotic surgical system. METHODS: In the study of 10 cases of bladder cancer, the robot-assisted radical cystectomy+expand lymphadenectomy+orthotopic bladder surgery with 60 degrees of Trendelenburg surgical position, was inserted into the manipulator under the video system monitor positioning, to complete the removal of the diseased tissue dissection and orthotopic ileal neobladder intra-abdominal. The respiratory parameters, hemodynamic parameters, arterial blood gas analysis were monitored and the waking time, intake and output, and intraoperative concurrent recorded. RESULTS: All the patients were operated successfully. The intraoperative blood loss was (342.9 ± 303.4) mL; the peak airway pressure increased after trendelenburg and high pneumoperitoneum; the mean arterial pressure heart rate and central venous pressure increased compared with the endotracheal intubation 15 minutes after two cases of the disease popularity abdominal end-expiratory CO2 partial pressure more than 50 mmHg, and PaCO2 higher than 60 mmHg in the arterial blood gas. When the respiratory parameters were adjusted, the hyperventilation showed no improvement, and when the pressure was reduced to less than 15 mmHg, the pneumoperitoneum improved; when metabolic acidosis occured in 2 patients, sodium bicarbonate post-correction was given; during surgery, 2 patients potassium rose to more than 5.5 mmol/L, gluconate and insulin were given; 5 patients developed multiple subcutaneous emphysema, of whom 1 was confined to the chest and abdomen, and 1 showed significant sense of gripping the snow from face to feet, associated with hypercapnia and temperature drop; the wake time (withdrawal to the extubation time) was (94.2 ± 35.6) min. CONCLUSION: Robot-assisted radical cystectomy + orthotopic bladder surgery is a newly-performed clinical surgery. Because of the huge machines, long time pneumoperitoneum and over-head-down, it is prone to acid-base balance and ion imbalance, thus increasing the difficulty and complexity to anesthesia management. It's necessary to further summarize the impact on the respiratory, hemodynamic, and nervous system.

A user-friendly interface for surgeons to create haptic effects in medical simulation.

Haptics, namely the sense of touch, has been playing an important role in medical simulation. However, most medical practitioners, who are best suited to create the training environments, do not have the engineering expertise necessary for programming a haptic environment. We propose a user-friendly interface that allows surgeons to arbitrarily select regions on a 3D model of an organ, similar to "painting-by-numbers", and tune the haptic properties of each region in an intuitive way. The selected region and tuned haptic properties are recorded in a lookup table in real-time. The proposed user interface is assessed by comparing the haptic effects of a tumor on a virtual liver created by a number of surgeons.