Summary of Lateral decubitus: its influence on hemodynamic and respiratory function during retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) in children
Retroperitoneal robotic-assisted laparoscopic pyeloplasty (R-RALP) is the most common urologic procedure performed in children, which involves retroperitoneal CO2 insufflation and lateral decubitus positioning. However, the effects of these factors on cardiopulmonary variables remain poorly understood. A study was conducted to investigate the hemodynamic and respiratory changes associated with CO2 insufflation and Lateral Decubitus in children undergoing R-RALP, as well as their effects on regional tissue oxygenation. The research took place at Necker Enfants Malades Hospital in Paris, France, between January 2021 and July 2024, involving children diagnosed with ureteropelvic junction obstruction (UPJO).
The study included 37 children, with a mean age of 6.0 years and a mean body weight of 22.5 kg. Patients were positioned either in Left Lateral Decubitus (LLD) or Right Lateral Decubitus (RLD) during the procedure. Various monitoring parameters were continuously recorded, including cerebral and renal Near InfraRed Spectroscopy (NIRS) values. The results indicated that no significant differences in standard monitoring parameters were observed between the LLD and RLD groups. However, the end-tidal CO2 (EtCO2) levels were higher in the RLD group at specific points during the procedure, whereas the Plateau Pressure (Pplat) was higher in the LLD group.
These findings suggest that the combination of RLD and CO2 insufflation may promote hypercarbia, while LLD could lead to increased Pplat pressures, potentially resulting in lung injury and hemodynamic instability during prolonged procedures. The study highlights the need for a lung-protecting anesthetic protocol to manage these risks effectively.
The results of this study further demonstrate the importance of understanding the physiological impacts of lateral decubitus positioning during R-RALP. While patient safety may be compromised, the implemented ventilation strategies helped maintain cerebral and renal perfusion-oxygenation, suggesting that with an appropriate approach, adverse effects on respiratory and hemodynamic function can be minimized. The study also emphasizes that anesthetists should be aware of the physiological changes that can occur during R-RALP, particularly differentiating between right and left lateral decubitus positioning, to anticipate the increased risk of hypercarbia in the RLD position and higher Pplat in the LLD position during longer surgeries.
In conclusion, the research provides valuable insights into the effects of lateral decubitus and CO2 insufflation on pediatric patients undergoing R-RALP, reinforcing the necessity for careful anesthetic management to ensure patient safety and optimal outcomes during surgical procedures.
SOURCE: https://link.springer.com/article/10.1007/s11701-024-02198-w
