Robotic laparoscopic radical cystectomy inhalational versus total intravenous anesthesia: a pilot study

Robotic assistance may refine laparoscopic radical cystectomy. Steep Trendelenburg tilt (TT) and pneumoperitoneum (PP) are challenging anesthesia maneuvers. In view of those maneuvers, would inhalational anesthesia or total intravenous anesthesia (TIVA) be the more appropriate anesthetic management for this kind of surgery? This issue is under consideration in this clinical trial.

15 patients scheduled for robotic laparoscopic radical cystectomy (RLRC) were randomly allocated into two groups to be anesthetized by either isoflurane anesthesia (ISO n = 8) or ketamine-midazolam-fentanyl total intravenous anesthesia (TIVA n = 7). The hemo-respiratory dynamics, oxygenation and biochemical variables were monitored taking into consideration the system organ function as primary outcomes, and operative conditions and recovery profile as secondary outcomes.

The PP and TT increased the mean arterial and airway pressures and decreased lung compliance, and were associated with respiratory acidemia, while changes in heart rate remained within normal range. The duration of PP was shorter in TIVA patients but mean arterial pressure was higher than ISO group. ISO was associated with increased plasma concentrations ofprothrombin, fibrinogen and aspartate aminotransferase.

Though the number of patients is small in this study (n = 15), it nevertheless brings to light the advantages of TIVA during the robotic laparoscopic radical cystectomy (RLRC), by shortening the duration of PP without an increase in prothrombin and fibrinogen concentrations. A lager number of clinical trial are needed to further clarify this issue.