[Anesthetic Management in Robotic-assisted Laparoscopic Radical Prostatectomy]

Robotic-assisted laparosopic prostatectomy (RALP) is the only robotic surgical procedure covered by na- tional health insurance in Japan, and its application has been spreading rapidly. This procedure is per- formed with the patient in the steep Trendelenburg position under pneumoperitoneum, and anesthesiolo- gists have to understand the physiological influences and accompanying risks. Regarding the pulmonary function, the lung compliance and functional residual capacity decrease as the airway pressure rises. It is important to appropriately maintain the airway pres- sure and prevent barotrauma and atelectasis. It is also necessary to pay attention to the risk of subcutaneous emphysema, brachial plexus palsy, peroneal neuropa- thy, pharyngeal edema, gas embolism, and postopera- tive ischemic optic nerve disorder. To prevent opera- tive complications, such as anastomotic leak between the bladder and urethra, the restrictive fluid manage- ment until the surgeon completes the vesicourethral anastomosis is recommended. It is important to load transfusion after the completion of anastomosis and pay attention to the water balance in order to prevent postoperative acute kidney injury. For RALP, close coordination among the surgeons, anesthesiologist, and medical staffs is essential for safe perioperative man- agement.