Nervous System Diseases

Heart and Blood Diseases

All Conditions

Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

Stroke

Prostatic Neoplasms

Urinary Bladder Neoplasms

Genital Neoplasms, Male

Urogenital Neoplasms

Genital Diseases

Genital Diseases, Male

Urogenital Diseases

Prostatic Diseases

Male Urogenital Diseases

Urologic Neoplasms

Female Urogenital Diseases

Pregnancy Complications

Female Urogenital Diseases and Pregnancy Complications

Urinary Bladder Diseases

Urologic Diseases

First, apply 10 cmH2O positive endexpiratory pressure (PEEP) and measure the increase in central venous pressure (CVP) as well as other preload indexes (central venous pressure, mean arterial pressure, stroke volume variation).

Second, measure the increase in cardiac index after administration of volulyte 300 ml.

If cardiac index increase more than 10%, fluid responsiveness is confirmed.

Administration of volulyte 300 ml and measurement of increase in cardiac index

Fluid loading of volulyte 300 ml

In urologic robotic surgery with steep Trendelenburg position, maintenance of cardiac preload and cardiac output is important for clinical prognosis. Previous studies reported the positive end-expiratory pressure (PEEP)-induced increase in central venous pressure (CVP) could be a accurate predictor of fluid responsiveness in cardiac surgical patients. The authors attempt to evaluate the predictability of PEEP-induced increase in CVP as well as stroke volume variation in urologic robotic surgery with Steep Trendelenburg position.

In urologic robotic surgery with steep Trendelenburg position, maintenance of cardiac preload and cardiac output is important for clinical prognosis. As a preload index, the predictability of central venous pressure, pulse pressure variation and stroke volume variations may be impaired due to the impaired hemodynamics that result from the effect of increased abdominal pressure and decreased venous return. Previous studies reported the positive end-expiratory pressure (PEEP)-induced increase in central venous pressure (CVP) could be a accurate predictor of fluid responsiveness in cardiac surgical patients. Therefore, the authors attempt to evaluate the predictability of PEEP-induced increase in CVP as well as stroke volume variation in urologic robotic surgery with Steep Trendelenburg position.

Positive End-expiratory Pressure-induced Increase in Central Venous Pressure as a Predictor of Fluid Responsiveness in Robot-assisted Laparoscopic Surgery

Comparison of Positive End-expiratory Pressure-induced Increase in Central Venous Pressure and Stroke Volume Variation to Predict Fluid Responsiveness in Robot-assisted Laparoscopic Surgery: A Prospective Clinical Trial

fluid responsiveness is determined when increase in cardiac index is more than 10%

T1: baseline measurement of central venous pressure with positive end-expiratory pressure of zero

T1: baseline measurement of cardiac index with positive end-expiratory pressure of zero

T1: baseline measurement of stroke volume variation with positive end-expiratory pressure of zero

T1: baseline measurement of abdominal pressure with positive end-expiratory pressure of zero

T2: measurement of positive end-expiratory pressure-induce increase in central venous pressure

T2: measurement of stroke volume variation

T3: second baseline measurement of central venous pressure with positive end-expiratory pressure of zero

T3: second baseline measurement of cardiac index with positive end-expiratory pressure of zero

T3: second baseline measurement of stroke volume variation with positive end-expiratory pressure of zero

T3: second baseline measurement of abdominal pressure with positive end-expiratory pressure of zero

measurement of central venous pressure after fluid administration

measurement of cardiac index after fluid administration

measurement of stroke volume variation after fluid administration

measurement of abdominal pressure after fluid administration

Seoul National University Hospital

Clinical Associate Professor

Digestive System Diseases

Pneumoperitoneum

Natriuretic Agents

All Drugs and Chemicals

Natriuretic Peptide, Brain

Jie Chen, MS

To optimize the perioperative management of patients undergoing laparoscopic radical cystectomy(LPC) for bladder cancer through observation of perioperative changes of Brain Natriuretic Peptide(BNP), stroke volume variation(SVV), central venous pressure(CVP) and the use of transthoracic echocardiography(TTE).

Long term pneumoperitoneum and steep trendelenburg in LPC for bladder cancer influence perioperative circulatory function, resulting in a series of pathophysiological changes. BNP is of high sensitivity and specificity in the evaluation of cardiac function. SVV and CVP are dynamic and static indices to predict fluid responsiveness. TTE is a good indicator of volume and cardiac function.Thus, we conducted the trial to assess the perioperative circulatory function in patients undergoing LPC. We hypothesized that long term pneumoperitoneum and steep trendelenburg in LPC for bladder cancer would increase perioperative blood volume and influence cardiac function.

Circulatory Function in Laparoscopic Radical Cystectomy for Bladder Cancer

Preliminary Study on the Changes of Perioperative Circulatory Function in Patients Undergoing Laparoscopic Radical Cystectomy for Bladder Cancer

To observe the change of BNP perioperatively.

To observe the change of CVP perioperatively.

To observe the change of SVV perioperatively.

To observe the change of End-diastolic volume(EDV) perioperatively

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Positive End-expiratory Pressure-induced Increase in Central Venous Pressure as a Predictor of Fluid Responsiveness in Robot-assisted Laparoscopic Surgery	NCT02977143	Prostatic Neopl... Urinary Bladder...	Fluid loading o...	20 Years -	Seoul National University Hospital
Positive End-expiratory Pressure-induced Increase in Central Venous Pressure as a Predictor of Fluid Responsiveness in Robot-assisted Laparoscopic Surgery	NCT02977143	Prostatic Neopl... Urinary Bladder...	Fluid loading o...	20 Years -	Seoul National University Hospital
Circulatory Function in Laparoscopic Radical Cystectomy for Bladder Cancer	NCT03892031	Circulatory Fun... Laparoscopic Ra...		18 Years - 90 Years	RenJi Hospital

Spots Global Cancer Trial Database for central venous pressure