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Minerva Anestesiologica 2019 August;85(8):871-85

DOI: 10.23736/S0375-9393.19.13360-3


lingua: Inglese

Joint consensus on anesthesia in urologic and gynecologic robotic surgery: specific issues in management from a task force of the SIAARTI, SIGO, and SIU

Paola ACETO 1, 2, Luigi BERETTA 3, Claudia CARIELLO 4, Claudia CLARONI 5, Clelia ESPOSITO 6, Ester M. FORASTIERE 5, Fabio GUARRACINO 4, Raffaella PERUCCA 7, Stefano ROMAGNOLI 8, 9, Liliana SOLLAZZI 1, 2, Vito CELA 10, Alfredo ERCOLI 11, Giovanni SCAMBIA 1, 2, Enrico VIZZA 12, Giuseppe M. LUDOVICO 13, Emilio SACCO 14, Giuseppe VESPASIANI 15, Luigia SCUDELLER 16 , Antonio CORCIONE 6, on behalf of Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva (SIAARTI), Società Italiana di Ginecologia e Ostetricia (SIGO), and Società Italiana di Urologia (SIU)

1 A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy; 2 Sacred Heart Catholic University, Rome, Italy; 3 Unit of Anesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy; 4 Department of Anesthesia and Critical Care Medicine, Cardiothoracic Anesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy; 5 Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy; 6 Department of Critical Care Area Monaldi Hospital, Ospedali dei Colli, Naples, Italy; 7 Department of Anesthesia and Intensive Care, Maggiore della Carità Hospital, Novara, Italy; 8 Section of Anesthesia and Critical Care, Health Science Department, University of Florence, Florence, Italy; 9 Department of Anesthesia and Critical Care, Careggi Hospital, Florence, Italy; 10 Department of Clinical and Experimental Medicine, Obstetrics and Gynecology, Pisa University Hospital, Pisa, Italy; 11 Department of Obstetrics and Gynecology, Amedeo Avogadro University of Eastern Piedmont, Maggiore Hospital, Novara, Italy; 12 Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy; 13 Department of Urology, F. Miulli Regional Hospital, Acquavivadelle Fonti, Bari, Italy; 14 Department of Urology, Sacred Heart Catholic University, A. Gemelli University Polyclinic, IRCSS Foundation, Rome, Italy; 15 Department of Experimental Medicine and Surgery, University Hospital of Tor Vergata, Rome, Italy; 16 Unit of Clinical Epidemiology, San Matteo IRCSS Foundation, Pavia, Italy

INTRODUCTION: Proper management of patients undergoing robotic-assisted urologic and gynecologic surgery must consider a series of peculiarities in the procedures for anesthesiology, critical care medicine, respiratory care, and pain management. Although the indications for robotic-assisted urogynecologic surgeries have increased in recent years, specific guidance documents are still lacking.
EVIDENCE ACQUISITION: A multidisciplinary group including anesthesiologists, gynecologists, urologists, and a clinical epidemiologist systematically reviewed the relevant literature and provided a set of recommendations and unmet needs on peculiar aspects of anesthesia in this field.
EVIDENCE SYNTHESIS: Nine core contents were identified, according to their requirements in urogynecologic robotic-assisted surgery: patient position, pneumoperitoneum and ventilation strategies, hemodynamic variations and fluid therapy, neuromuscular block, renal surgery and prevention of acute kidney injury, monitoring the Department of anesthesia, postoperative delirium and cognitive dysfunction, prevention of postoperative nausea and vomiting, and pain management in endometriosis.
CONCLUSIONS: This consensus document provides guidance for the management of urologic and gynecologic patients scheduled for robotic-assisted surgery. Moreover, the identified unmet needs highlight the requirement for further prospective randomized studies.

KEY WORDS: Robotic surgical procedures; Urology; Gynecology; Anesthesia; Pneumoperitoneum

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