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. 2017 Jul-Sep;11(3):279-282.
doi: 10.4103/sja.SJA_560_16.

An observational study: Effects of tenting of the abdominal wall on peak airway pressure in robotic radical prostatectomy surgery

Avinash Sahebarav Kakde  1 , Harshal D Wagh  1
Affiliations

An observational study: Effects of tenting of the abdominal wall on peak airway pressure in robotic radical prostatectomy surgery

Avinash Sahebarav Kakde et al. Saudi J Anaesth. 2017 Jul-Sep.

Abstract

Background: Robotic radical prostatectomy (RRP) is associated with various anesthetic challenges due to pneumoperitoneum and deep Trendelenburg position. Tenting of the abdominal wall done in RRP surgery causes decrease in peak airway pressure leading to better ventilation. Herein, we aimed to describe the effects of tenting of the abdominal wall on peak airway pressure in RRP surgery performed in deep Trendelenburg position.

Methods: One hundred patients admitted for RRP in Kokilaben Dhirubhai Ambani Hospital of American Society of Anesthesiologists 1 and 2 physical status were included in the study. After undergoing preanesthesia work-up, patients received general anesthesia. Peak airway pressures were recorded after induction of general anesthesia, after insufflation of CO2, after giving Trendelenburg position, and after tenting of the abdominal wall with robotic arms.

Results: Mean peak airway pressure recording after induction in supine position was 19.5 ± 2.3 cm of H2O, after insufflation of CO2 in supine position was 26.3 ± 2.6 cm of H2O, after giving steep head low was 34.1 ± 3.4 cm of H2O, and after tenting of the abdominal wall with robotic arms was 29.5 ± 2.5 cm of H2O. P value is highly statistically significant (P = 0.001).

Conclusion: Tenting of the abdominal wall during RRP is beneficial as it decreases peak airway pressure and helps in better ventilation and thus reduces the ill effects of raised peak airway pressure and intra-abdominal pressures.

Keywords: Gasless laparoscopic surgery; pneumoperitoneum; robotic radical prostatectomy; tenting.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Tenting during gasless laparoscopic surgery (image obtained from Google search engine)
Graph 1
Graph 1
Peak airway pressure in various positions of the patient during surgery × mean peak airway pressure after induction was 19.5 ± 2.3 cm of H2O, after insufflation of CO2 was 26.3 ± 2.6, after steep head low was 34.1 ± 3.4, and after tenting of the abdominal wall was 29.5 ± 2.5. †unit for mean peak airway pressure is cm of H2O
Figure 2
Figure 2
Before tenting of abdominal wall (original picture taken in the operation theater with mobile phone camera)
Figure 3
Figure 3
After tenting of abdominal wall (original picture taken in the operation theater with mobile phone camera)
Figure 4
Figure 4
Photograph after docking and tenting of abdominal wall (original picture taken in the operation theater with mobile phone camera)
See this image and copyright information in PMC

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