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ANASTHESIA MANAGEMENT IN LAPROSCOPIC RADICAL PROSTATECTOMY

Dr Unaiza Shahid, Dr Amna Cheema, Dr Anum Ghaffar

Abstract: Objective: Laparoscopic radical prostatectomy [LRP] provides effectively results on surgical, oncological and functional in patients with localized prostate cancer. LRP that has a rapid recovery, returning to normal life activities in a short time affects the quality of life positively. Furthermore, mandatory of general anesthesia and specific patient position, long operation time and increased intra-abdominal pressure caused by the pneumoperitoneum. In our study, the aim was to present the anesthesia applied in LRP. Material and Methods: This is a retrospective type of cross sectional study, conducted from March 2018-February 2019. Results: Thirty-three patients were selected for the present study. Three of them, were then excluded out the study as their data was missing from records. 30 patients were enrolled in our study. Their data was collected from their file and records of anesthesia. Their ages, gender, duration of anesthesia, agents used in anesthesia, ASA, IV fluids, post-operative analgesic use, amount of bleeding and invasive interventions used on the patients were recorded. The qualitative and quantitative variables were recorded and analyzed with the help of SPSS version 21.0. The stratification of the effect modifiers was done and post stratification chi square test was applied with p<0.05. The results of 30 patients study was analyzed in our study. The mean age of the cases who underwent LRP was 64.51 ±3.76 years. Six of the patients were ASA I; 15 of them were ASA II, 9 patients were ASA III. The blood pressure monitoring of all the patients enrolled was carried out with invasive radial artery monitoring. The Intra venous fluid infusion management was being done with normal saline in 15 patients, and with normal saline plus colloid in 15 patients. None of the cases needed blood transfusion. 20 of the patients received lumbar catheter for epidural anesthesia; and 3 mg of morphine was given intraoperatively with the epidural catheter after dilution with normal saline as 15 cc. Postoperatively, epidural analgesia was given with morphine. The analgesia of 5 patients who did not give consent for epidural catheter, and 6 patients whose lumbar catheter attachment was not successful, was given IV analgesia by using morphine. The mean time taken for surgery, on the table, was 319.75±89.06 minutes; and the bleeding recorded was 238.43±105.64 ml. After surgery is done, all of the patients were extubated and sent to Intensive Care Unit. Conclusion: Hemodynamic and vitals monitoring is must during high risk operations like LPR and better patient outcome and prognosis. Keywords: Prostate Cancer, Laparoscopic Radical Prostatectomy, Oncological, Anesthesia, Pneumoperitoneum, Hemodynamic.

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