Neoplasms

Urinary Tract, Sexual Organs, and Pregnancy Conditions

All Conditions

Prostatic Neoplasms

Genital Neoplasms, Male

Urogenital Neoplasms

Genital Diseases

Genital Diseases, Male

Urogenital Diseases

Prostatic Diseases

Male Urogenital Diseases

Central Nervous System Depressants

All Drugs and Chemicals

Other Dietary Supplements

Anesthetics

Benzocaine

Tannic Acid

Randomized 23 patients will be applied VCV during RALP.

Randomized 23 patients will be applied autoflow-VCV during RALP.

After induction of anesthesia and intubation, patients will be applied VCV by Zeus®(Dräger, Germany).

- Tidal volume : 8ml/kg(ieal body weight), inspiration:expiration ratio = 1:2, FiO2 = 0.5, fresh gas flow = 3L/min respiratory rate(RR) : 12/min. After position, RR can changed 2 times each per 5 minutes to maintain end tidal CO2 around 35. Positive end expiratory pressure will not used.

volume controlled ventilation

After induction of anesthesia and intubation, patients will be applied autoflow- VCV by Zeus®(Dräger, Germany).

- Tidal volume : 8ml/kg(ideal body weight), inspiration:expiration ratio = 1:2, FiO2 = 0.5, fresh gas flow = 3L/min respiratory rate(RR) : 12/min. After position, RR can changed 2 times each per 5 minutes to maintain end tidal CO2 around 35. Positive end expiratory pressure will not used.

autoflow-volume controlled ventilation

Hye-Won Shin, MD, PhD

Volume controlled ventilation(VCV) is a most common used ventilation mode during general anesthesia. But VCV can cause high airway peak pressure when patient under steep Trendelenberg position with pneumoperitoneum. Autoflow-VCV can reduce airway peak pressure and improve dynamic compliance. We will compare parameters(arterial blood gas analysis, airway compliance, etc) when each group applied VCV and autoflow-VCV during RALP.

Robot assisted laparoscopic radical prostatectomy(RALP) has been used to treatment of prostate cancer since 2001. RALP offers some advantage such as reduced blood loss, sparing nerves, less postoperative pain. However, RALP require steep Trendelenberg position with pneumoperitoneum. It can cause increased airway peak pressure and unwanted hemodynamic effect under conventional volume controlled ventilation(VCV). Autoflow-VCV use decelerating flow, can reduce airway peak pressure and improve dynamic compliance.

We will compare parameters(arterial blood gas analysis, airway compliance, etc) when each group applied VCV and autoflow-VCV during RALP.

Volume Controlled Ventilation vs Autoflow-volume Controlled Ventilation

Comparison of Volume Controlled Ventilation(VCV) vs Autoflow-volume Controlled Ventilation(Autoflow-VCV) During Robot-assisted Laparoscopic Radical Prostatectomy

Arterial blood gas analysis will be measured under specified ventilation mode.

Airway pressure will be measured under specified ventilation mode.

Vital sign will be measured under specified ventilation mode.

Korea University Anam Hospital

Director, MD, PhD

Respiratory Tract (Lung and Bronchial) Diseases

Wounds and Injuries

Lung Injury

Lung Diseases

Respiratory Tract Diseases

Thoracic Injuries

patients will be allocated to pressure-controlled ventilation volume guaranteed in operation

patients will be allocated to volume controlled ventilation in operation

patients will be allocated to pressure-controlled ventilation-volume guaranteed in operation

pressure-controlled ventilation-volume guaranteed

Dongxue Li

Sanqing Jin, MD

In 1967, the term "respirator lung" was coined to describe the diffuse alveolar infiltrates and hyaline membranes that were found on postmortem examination of patients who had undergone mechanical ventilation.This mechanical ventilation can aggravate damaged lungs and damage normal lungs. In recent years, Various ventilation strategies have been used to minimize lung injury, including low tide volume, higher PEEPs, recruitment maneuvers and high-frequency oscillatory ventilation. which have been proved to reduce the occurrence of lung injury.

In 2012,Needham et al. proposed a kind of lung protective mechanical ventilation, and their study showed that limited volume and pressure ventilation could significantly improve the 2-year survival rate of patients with acute lung injury.Volume controlled ventilation is the most commonly used method in clinical surgery at present.Volume controlled ventilation(VCV) is a time-cycled, volume targeted ventilation mode, ensures adequate gas exchange. Nevertheless, during VCV, airway pressure is not controlled.Pressure controlled ventilation（PCV） can ensure airway pressure,however minute ventilation is not guaranteed.Pressure controlled ventilation-volume guarantee(PCV-VG) is an innovative mode of ventilation utilizes a decelerating flow and constant pressure. Ventilator parameters are automatically changed with each patient breath to offer the target VT without increasing airway pressures. So PCV-VG has the advantages of both VCV and PCV to preserve the target minute ventilation whilst producing a low incidence of barotrauma pressure-targeted ventilation.

Current studies on PCV-VG mainly focus on thoracic surgery, bariatric surgery and urological surgery, and the research indicators mainly focus on changes in airway pressure and intraoperative oxygenation index.The age of patients undergoing laparoscopic colorectal cancer resection is generally higher, the cardiopulmonary reserve function is decreased, and the influence of intraoperative pneumoperitoneum pressure and low head position increases the incidence of intraoperative and postoperative pulmonary complications.Whether PCV-VG can reduce the incidence of intraoperative lung injury and postoperative pulmonary complications in elderly patients undergoing laparoscopic colorectal cancer resection, and thereby improve postoperative recovery of these patients is still unclear.

One hundred patients undergoing elective laparoscopic colorectal cancer resection (age \> 65 years old, body mass index(BMI）18-30 kg/m2, American society of anesthesiologists(ASA )grading Ⅰ - Ⅲ ) will be randomly assigned to volume control ventilation(VCV)group and pressure controlled ventilation-volume guarantee(PCV-VG)group.General anesthesia combined with epidural anesthesia will be used to both groups.

Ventilation settings in both groups are VT 8 mL/kg,inspiratory/expiratory (I/E) ratio 1:2,inspired oxygen concentration (FIO2) 0.5 with air,2.0 L/min of inspiratory fresh gas flow,positive end-expiratory pressure (PEEP) 0 millimeter of mercury （mmHg）,respiratory rate (RR) was adjusted to maintain an end tidal CO2 pressure (ETCO2) of 35 -45 mmHg.

In operation dates will be collected at the following time points: preanesthesia, 1 hour after pneumoperitoneum,2 hours after pneumoperitoneum ,30 minutes after admission to post-anaesthesia care unit (PACU) .The dates collected or calculated are the following:1)peak airway pressure,plate airway pressure, mean inspiratory pressure, dynamic compliance, RR,Exhaled VT andETCO2，2) Arterial blood gas analysis: arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2),power of hydrogen（PH）, and oxygen saturation (SaO2)，3) Oxygenation index (OI) calculation; PaO2/FIO2, 4) Ratio of physiologic dead-space over tidal volume(Vd/VT) (expressed in %) was calculated with Bohr's formula ; Vd/VT = (PaCO2 - ETCO2)/PaCO2,5) Hemodynamics: heart rate, mean arterial pressure (MAP),and central venous pressure （CVP），6) lung injury markers ：Interleukin 6(IL6）,Interleukin 8（IL8）,Clara cell protein 16（CC16）,Solution advanced glycation end products receptor（SRAGE）,tumor necrosis factor α(TNFα) .

Investigators will collect the following dates according to following-up after surgery: the incidence of postoperation pulmonary complications(PPC) based on PPC scale within seven days , incidence of pneumonia within seven days after surgery,incidence of atelectasis within seven days after surgery,length of hospital days after surgery, the incidence of postoperative unplanned admission to ICU, the incidence of operation complications within 7 days after surgery, the incidence of postoperative systematic complications within 7 days after surgery.

Effects of Different Ventilation Patterns on Lung Injury

Effects of Different Ventilation Modes on Intraoperative Lung Injury and Postoperative Pulmonary Complications in Elderly Patients Undergoing Laparoscopic Colorectal Cancer Resection

Pulmonary complications were assessed using the Postoperation Pulmonary complication ( PPC) scale,The scale is divided into four grades, with 0 indicating no pulmonary complications and 1 to 4 indicating increasingly severe pulmonary complications.

record the occurrence rate of pneumonia after surgery

record the occurrence rate of pulmonary atelectasis after surgery

Plateau airway pressure（Pplat, cm H2O）

Static lung compliance (Csta, ml/cm H2O) = Vt/ (Pplat-PEEP)

Dynamic lung compliance (Cdyn , ml/cm H2O)= Vt/ (Ppeak-PEEP)

Arterial partial pressure of oxygen (PaO2, mmHg）

Alveolar-arterial oxygen tension difference (mmHg）

Fraction of inspired oxygen (FiO2); Respiratory index (RI) =Ratio of alveolar-arterial oxygen tension difference to FiO2

Arterial carbon dioxide partial pressure (PaCO2); partial pressure of carbon dioxide in endexpiratory gas (PetCO2); Alveolar dead space fraction (Vd/Vt）=(PaCO2-PetCO2)/ PaCO2;

Advanced glycation end products receptor (RAGE, pg/ml)

Tumor Necrosis Factor alpha (TNF-α, pg/ml)

The occurrence rate of hypoxemia (SPO2\<90% or PaO2\<60 mmHg) in PACU

abdominal abscess, anastomotic fistula, bleeding and the incidence of reoperation within 7 days

Systemic complications including sepsis and septic shock

record the Antibiotic dosages within 7 days after surgery

Unplanned admission to ICU within 30 days after surgery

Length of ICU stay within 30 days after surgery

Length of hospital stay within 30 days after surgery

Death from any cause 30 days after surgery

The occurrence rate of hypoxemia (SPO2\<90% or PaO2\<60 mmHg) after surgery

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Volume Controlled Ventilation vs Autoflow-volume Controlled Ventilation	NCT02512120	Prostate Cancer	volume controll... autoflow-volume...	19 Years - 80 Years	Korea University Anam Hospital
Effects of Different Ventilation Patterns on Lung Injury	NCT03960853	Lung Injury	pressure-contro... volume controll...	65 Years -	Sixth Affiliated Hospital, Sun Yat-sen University

Spots Global Cancer Trial Database for volume controlled ventilation