Anesthesia recovery nursing of radical prostatectomy assisted by Da Vinci robot

doi:10.21203/rs.3.rs-3343734/v1

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Research Article

Anesthesia recovery nursing of radical prostatectomy assisted by Da Vinci robot

https://doi.org/10.21203/rs.3.rs-3343734/v1

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Objective To explore the anesthetic recovery nursing of laparoscopic radical prostatectomy with Da Vinci robot.

Methods A total of 100 patients who underwent Da Vinci robotic laparoscopic radical prostatectomy at our hospital between July 2021 and July 2022 were randomly assigned to 2 groups with 50 patients in each group. Patients in the control group were treated with routine nursing, patients in the research group were treated with Da Vinci specialist group perianaesthesia nursing on the basis of the control group, and the difference of anesthesia recovery nursing effect between the two groups was compared.

Results The waking time, spontaneous breathing time, extubation time and total recovery time in the study group were significantly lower than those in the control group, and the daily sleep time was significantly higher than that in the control group, with statistical significance (P<0.05). HR, MAP, VAS and PSQI in study group were lower than those in control group. The difference was statistically significant (P<0.05). The nursing satisfaction of patients in the study group was significantly higher than that in the control group, and the incidence of nursing risk events was significantly lower than that in the control group, with statistical significance (P<0.05).

Conclusion The Da Vinci robot can effectively reduce the pain in the early stage of recovery, improve the sleep quality, shorten the recovery time from anesthesia, improve the psychological state of patients and reduce the occurrence of nursing risk events, which is worth promoting in clinical practice.

Da Vinci robot-assisted laparoscopy

Radical prostatectomy

Anesthesia recovery

nursing

What is already known

Anesthetic recovery nursing acts as a critical role during the perioperative period.

Robot-assisted radical prostatectomy is reliant on general anesthesia.

Currently, no research investigates the anesthetic recovery nursing after robot-assisted radical prostatectomy.

What this paper adds

Professional robot anesthesia nursing could significantly reduce the waking time, spontaneous breathing time, extubation time and total recovery time compared with traditional anesthesia resuscitation care.

Professional robot anesthesia nursing had no advantages on pain relief and sleep quality improvement compared with traditional anesthesia resuscitation care.

Professional robot anesthesia nursing could increase the satisfaction of patients.

According to the epidemiological investigation results, prostate cancer ranks the second in incidence and the first in mortality among male malignant tumors worldwide, seriously threatening the physical and mental health of middle-aged and elderly men (Carlsson & Vickers, 2005; Sehn,2018). China's aging population and environmental pollution have led to an annual increase in the incidence of prostate cancer (Schatten, 2018). There are many treatment methods for prostate cancer (Ritch & Cookson, 2018), so radical prostatectomy is one of the most studied methods for prostate cancer. In the past, open surgical approaches have defects such as large surgical wounds, high blood loss, and postoperative adverse complications (Bill-Axelson & Holmberg & Garmo et al., 2018). The application of laparoscopy in the treatment of prostate cancer has the advantages of small incision, small injury and direct vision of tissue structure. However, it is limited by surgical instruments and operating space (Ilic & Evans & Allan et al., 2018). With the development of science and technology, medical robots are also applied in laparoscopic radical prostatectomy. Compared with traditional and laparoscopic surgical methods, the application of Da Vinci robot has better intraoperative field of vision, surgical accuracy, surgical trauma, postoperative outcome and perioperative experience (Cao & Yang & Qi & Chen M, 2019). However, general anesthesia is used in the above three operations. At present, the research of Da Vinci robot-assisted laparoscopic anesthesia recovery nursing in radical prostatectomy is relatively scarce. Therefore, in this study, 100 patients with prostate cancer admitted to our hospital were selected as the research object to explore the anesthetic recovery nursing research of Da Vinci robot-assisted laparoscopic radical prostatectomy, providing basis for clinical related research. The results are as follows.

2.1 General Information

A total of 100 patients with Da Vinci robot laparoscopic radical prostatectomy in our hospital from between July 2021 and July 2022 were selected as the study subjects, and they were divided into 2 groups with 50 patients in each group by random number table method. Patients in the control group were treated with routine nursing, and patients in the research group were treated with Da Vinci specialist group perianaesthesia nursing on the basis of routine nursing. In the control group, there were 50 males, aged 65.45 ± 5.23 years. There were also 50 males in the study group, with an average age of 61.11 ± 4.29 years. There was no significant difference in age and sex between the two groups (P > 0.05).

2.2 Inclusion and exclusion criteria

Inclusion criteria :(1) age ≥ 40; (2) patients who met the indications of radical prostatectomy in National Comprehensive Cancer Network(NCCN)Prostate Guidelines (Schaeffer & Srinivas & Antonarakis et al., 2021); (3) Both patients and their families gave informed consent to the study and signed consent forms.

Exclusion criteria :(1) Patients who cannot tolerate radical prostatectomy; (2) patients receiving endocrine therapy before radical prostatectomy; (3)Incomplete clinical data.

2.3 Research Methods

The control group received routine care, including health education, psychological counseling and traditional anesthesia resuscitation care. On the basis of the control group, patients in the study group were added the Da Vinci specialist group for perianaesthesia nursing, mainly including:

(1) Robot nursing team: Robot surgery is complex and delicate, and has high requirements for details of anesthesia care. The department needs to establish a professional robot anesthesia nursing cooperation team, which is composed of nurses who have passed the systematic training and examination of the department special committee, and are required to master the perianesthesia nursing of Da Vinci Specialist group.

(2) Environmental management: the indoor temperature should be controlled at 22–24 ℃ and humidity should be controlled at 50%-60%. The resuscitate unit should prepare equipment such as kindly electric monitoring, ventilator and negative pressure suction, and prepare first-aid items. Try to arrange patients to beds near the nurse station.

(3) Monitoring and maintenance of respiratory tract: ①If the tracheal tube is not removed, adjust ventilator parameters to assist breathing as instructed by the doctor, and closely monitor the waveform and frequency of breathing. ②Patients with tracheal tube removed were given continuous oxygen inhalation by mask to maintain oxygen saturation above 94%, and patients' vital signs were monitored. ③To guide the breath and cough after waking, smoking history, most patients with tracheal intubation in the process of the respiratory tract, there will be a certain degree of damage of postoperative patients stay in bed for a long time, and the reason of wound pain can't do take a deep breath and cough movement, after pulling the endotracheal tube should do explain the necessity of respiratory function training, guide the patients to learn effective respiratory function exercise, prevent the occurrence of pulmonary complications.

(4) Posture care: the head of the bed is raised 15–20°, which is conducive to drainage and breathing. After the patient is awake, the patient should be assisted to take a comfortable posture.

(5) Complications related to artificial CO2 pneumoperitoneum: Due to high intraoperative pneumoperitoneum pressure, long operation time and other reasons, excessive CO2 is easily absorbed intraoperatively, which may cause subcutaneous emphysema and hypercapnia. ETCO2 and respiratory status can be monitored continuously after surgery, and blood gas indicators can be monitored repeatedly if necessary. When patients have CO2 storage,ventilation can be increased by adjusting respiratory rate or tidal volume to correct insufficient ventilation and avoid acid-base metabolism imbalance.

(6) Agitation nursing: Patients with long-term robotic surgery have a high incidence of postoperative agitation and delirium, and rapid hyperventilation should be avoided. In order to avoid overcorrection, at the same time do a good job of patient restraint. Postoperative pain and patients' discomfort to the pipeline may be important factors of agitation, which can be prevented and corrected by using sedative and analgesic drugs as prescribed by the doctor.

(7) Pain care: the postoperative pain of robotic surgery is lighter than that of traditional open surgery. Patients' expectations for minimally invasive surgery and requirements for rapid postoperative recovery make the postoperative analgesia more demanding. When the VAS ≥ 4, and the patient appears irritable, rapid pulse, hypertension, etc., the doctor should be informed as soon as possible, and symptomatic treatment such as analgesia, antihypertensive should be given. When VA ≤ 3 points, if the patient can tolerate pain, the patient can be assisted to press the analgesic pump to relieve pain.

(8) Pipeline care: To ensure the smooth flow of infusion tubes and drainage tubes, straighten out the messy pipes, fix all kinds of drainage tubes and make good marks. At the same time, closely monitor the inflow and outflow, squeeze the drainage tube every hour, pay attention to the drainage flow and drainage color, and timely remind the doctor of any abnormality

(9) Wound care: although the wound is small, there are many wounds. It is necessary to carefully observe whether the wound oozes blood and fluid, and whether the dressing is dry.

(10) Temperature care: the postoperative time is long, so that patients are prone to postoperative hypothermia, easy to cause chills, so postoperative temperature detection should be routine. And use heating equipment to keep warm, prevent and treat adverse complications caused by hypothermia.

(11) Skin care: The robot operation time is longer than laparotomy and laparoscopic surgery. In addition, due to the gravity of the robotic arm, the patient is older, which is easy to lead to different degrees of congestion and edema of soft tissue. Therefore, the observation of the skin of the ribs on both sides is strengthened.

(12) Psychological nursing: Try to meet the needs of patients, help to build a positive mindset, improve the quality of service and patient satisfaction.

(13) Health education: When leaving the PACU, make a good case transfer to the surgeon, and teach the use of analgesia pump to the patients and their families.

2.4 Observation Indicators

(1) The differences of heart rate (HR) and mean arterial pressure (MAP) between the two groups before and after nursing were recorded.

(2) Postoperative indicators of the two groups were recorded, including wake time, spontaneous breathing time, extubation time, daily sleep time and total recovery time.

(3) The differences of pain and sleep quality between the two groups before and after nursing were evaluated, and visual analogue scale (VAS) was used for pain (Myles & Myles & Galagher W et al., 2017). A score of 0 is no pain and 10 is severe pain. The sleep quality was evaluated by Pittsburgh Sleep Index scale (PSQI) (Almojali & Almalki & Alothman et al., 2017), with 18 self-rated items in total. Each component is scored on a scale of 0 to 3, and the final cumulative score is 0 to 21 points. The higher the score, the worse sleep quality.

(4) The difference in postoperative satisfaction and postoperative nursing risk rate between the two groups were evaluated, and the satisfaction was evaluated by a self-made questionnaire of our hospital (Dunstan & Scott, 2020; Xie & Liang & Lu et al., 2021). The full score is 100, the higher the score is, the better the patient satisfaction is, and the incidence of adverse symptoms includes the incidence of complications such as agitation, pain.

2.5 Statistical methods

All data were processed with SPSS20. The comparison of counting data between the two groups was expressed as n or percentage, and chi-square test was used. The comparison of measurement data between the two groups was expressed as standard deviation ± mean and t test was used. P < 0.05 was considered as statistically significant difference.

3.1 Comparison of physiological indicators between the two groups

There was no significant difference in HR and MAP between the two groups before nursing (P > 0.05), but HR and MAP were significantly decreased in both groups after nursing. HR and MAP in the study group were lower than those in the control group, and the differences were statistically significant (P < 0.05), as shown in Table 1. Figure 1.

Table 1

comparison of physiological indicators between the two groups
Group		Study group (n = 50)	Control group (n = 50)	T	P
HR	Before the nursing	97.48 ± 2.58	97.53 ± 3.48	0.001	0.970
	After the nursing	78.89 ± 1.14	85.37 ± 7.66	36.891	0.000
MAP	Before the nursing	116.95 ± 10.23	116.47 ± 11.11	0.158	0.691
	After the nursing	90.42 ± 2.13	105.37 ± 9.75	138.831	0.000

3.2 Comparison of postoperative anesthesia recovery indicators between the two groups

The waking time, spontaneous breathing time, extubation time and total recovery time of the study group were significantly lower than that of the control group, and the daily sleep time was significantly higher than that of the control group, with statistical significance (P < 0.05), as shown in Table 2. Figure 2.

Table 2

Comparison of postoperative anesthesia recovery indicators between the two groups
Group	Study group (n = 50)	Control group (n = 50)	T
Wake up time (min)	20.35 ± 1.53	27.62 ± 2.21	217.020
Spontaneous breathing time (min)	17.72 ± 0.55	23.12 ± 0.67	1226.436
Tube pulling time (min)	22.27 ± 2.78	30.19 ± 3.75	134.554
Total recovery time(min)	80.98min	90.64min	360.482
Daily sleep time (h)	6.27 ± 0.52	4.95 ± 0.35	129.201

3.3 Differences in pain and sleep quality between the two groups

There was no significant difference in VAS and PSQI between the two groups before nursing (P > 0.05), and VAS and PSQI in the two groups were significantly decreased after nursing, and VAS and PSQI in the study group were lower than those in the control group, with statistical significance (P < 0.05), as shown in Table 3. In Fig. 3.

Table 3

Differences in pain and sleep quality between the two groups
Group		Study group (n = 50)	Control group (n = 50)	T	P
VAS	Before the nursing	3.61 ± 0.15	4.10 ± 0.12	69.201	0.000
	After the nursing	2.01 ± 0.13	2.75 ± 0.23	56.669	0.000
PSQI	Before the nursing	13.65 ± 1.23	13.27 ± 1.54	0.269	0.605
	After the nursing	6.75 ± 1.03	10.52 ± 1.11	109.900	0.000

3.4 Differences in patient satisfaction and nursing risk events between the two groups

The nursing satisfaction of patients in the study group was significantly higher than that in the control group, and the incidence of nursing risk events was significantly lower than that in the control group, with statistical significance (P < 0.05), as shown in Table 4. Figure 4.

Table 4

Differences in patient satisfaction and nursing risk events between the two groups
Group		Study group (n = 50)	Control group (n = 50)	T	P
Nursing satisfaction		85.45 ± 5.32	74.31 ± 2.35	178.764	0.000
Nursing risk events	Restlessness	5	7	1.502	0.220
	Hypertensive	6	9	2.795	0.095
	Pain	4	7	3.653	0.056
	Total	4	16	33.763	0.000

The operation of prostate cancer, more laparoscopic radical prostatectomy. Compared with open surgery, laparoscopic radical prostatectomy has a wide field of vision and relatively small trauma, but the technology and equipment requirements of laparoscopic radical prostatectomy are relatively high (Lantz et al., 2021; Schitcu et al., 2021). The Da Vinci Surgical System is a cutting-edge surgical robot platform with extremely high resolution. Compared to traditional laparoscopy, the neurovascular bundle can be identified for protection through multiple angles of exploration inside the abdominal cavity (Amornratananont et al., 2020). In addition to reducing the amount of blood loss, it can also timely and accurately hemostasis, so it has a good application prospect (George & Brand & LaPorta et al., 2018). However, it also requires a larger surgical field and operating space, so it generally requires a long time of CO₂ injection and higher pneumoperitoneum pressure, which is more likely to lead to the retention of CO₂ and thus the disorder of the internal environment (Yamamoto & Nishihara & Hamada et al., 2021). At the same time, the need for special positions leads to increased intrathoracic pressure, resulting in reduced lung compliance and an increased risk of postoperative respiratory complications (Kim & Kim & Kim et al., 2021). The above factors lead to more complex and difficult anesthesia management for patients undergoing robotic laparoscopic radical prostatectomy.

The results of this study indicated that the waking time, spontaneous breathing time, extubation time and total recovery time of the study group were significantly lower than that of the control group, and the daily sleep time was significantly higher than that of the control group. HR, MAP, VAS and PSQI of the two groups were significantly decreased after nursing, and the study group were lower than those of the control group. It is suggested that the application of Da Vinci specialist group perianaesthesia nursing can significantly reduce the recovery time of general anesthesia, HR and MAP for patients undergoing laparoscopic radical prostatectomy with Da Vinci robot, and has little influence on patients' psychological status and sleep quality. At present, there are few nursing research results for radical prostatic cancer abroad, and most of the research on anesthesia nursing mode is based on the concept of rapid recovery. For example, Santa et al. (2018) showed that pre-rehabilitation included family-based moderate intensity exercise before surgery. Although it is feasible and safe, pre-rehabilitation has significant physical and mental health benefits at significant points in time compared to radical prostatectomy. Kishikawa et al. (2021) showed that robot-assisted surgery requires different anesthetic consumption and infusion management during minimally invasive radioguided parathyroidectomy (MIRP) under General and Epidural Anesthesia. It also reduces the length of postoperative hospital stay without increasing the incidence of postoperative complications. Yonekura et al. (2016) showed that compared with traditional laparoscopic radical prostatectomy (LRP) surgery, anesthesiologists could expect robot-assisted laparoscopic radical prostatectomy(RALP) surgery to be associated with less blood loss and the need for fewer blood products. Aside from the high incidence of postoperative nausea and vomiting, the anesthetic results of RALP were generally satisfactory. The results above all confirm the effectiveness of Da Vinci specialist group perianaesthesia nursing for patients with Da Vinci robot-assisted laparoscopic radical prostatectomy. The specific reason may be because the patient is in the anesthesia recovery period, more sensitive to pain. However, the nursing model in this study can timely reflect the pain degree of patients by testing PATIENTS 'HR and MAP, and then give patients sufentanil as directed and other drugs for analgesia to quickly reduce pain and reduce patients' HR, MAP and VAS (Lai & Lee & Lin & et al., 2020). In addition, the surgical method in this study is robot-assisted laparoscopy, which takes a long time and may cause acidosis due to excessive CO2. Moreover, the detection of the above indicators can also provide patients with 95% or more oxygen saturation in a timely manner (Yuce & Erkal & Goktas & et al., 2017). There are also studies showing that the occurrence of negative emotions and patients' pain interact, so timely psychological nursing and humanistic care of patients in this study can reduce patients' feelings of irritability and anxiety, so as to relieve pain. In addition, during the nursing process, the guidance of deep breathing and coughing may also reduce the tension of patients and the possibility of pulmonary complications, which also leads to the results of this study showing that the nursing satisfaction of patients in the study group is significantly higher than that in the control group (Zhang & Bi & Hou et al., 2021; Hoshikawa & Tochii, 2017 ). However, the incidence of nursing risk events in the study group was significantly lower than that in the control group, which may be related to the risk prevention given after surgery, namely the application of restraint belt, which prevented the occurrence of adverse time such as pain and trauma.

In conclusion, Da Vinci robot-assisted specialist group perianaesthesia nursing for patients undergoing laparoscopic radical prostatectomy can effectively reduce the pain in the early stage of recovery, improve the sleep quality of patients, shorten the recovery time from anesthesia,and reduce the occurrence of nursing risk events, which is worthy of promotion in clinical practice.

Ethics approval and consent to participate

This clinical study was reviewed and approved by the Ethics Committee of Sun Yat-sen University First Affiliated Hospital. All patients signed the informed consent for using their clinical data.

Consent for publication

Not applicable.

Availability of data and materials

All data generated or anas study are available from the corresponding author upon request.

Competing interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Funding

There is no funding in this research.This work was supported by grant from Clinical research Fund project of Anesthesiology Branch of Guangdong Medical Association, China (No. GDSA202203003). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Authors’ contributions

JT and SW did the overall design of the research. JT and LH wrote the protocol and approve the manuscript before submission. JL and WW searched the studies, quantified the risk of bias, extracted data from the original studies and wrote the manuscript. YW contributed to the search strategy and the overall outline of the manuscript. FL and SW helped with data management and the revision process. All authors have read and approved the manuscript.

Acknowledgements

Not applicable.

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No competing interests reported.

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You are reading this latest preprint version

Anesthesia recovery nursing of radical prostatectomy assisted by Da Vinci robot

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Version 1

Abstract

Figures

Contribution of the Paper

1. Introduction

2. Data and methods

2.1 General Information

2.2 Inclusion and exclusion criteria

2.3 Research Methods

2.4 Observation Indicators

2.5 Statistical methods

3. Results

3.1 Comparison of physiological indicators between the two groups

3.2 Comparison of postoperative anesthesia recovery indicators between the two groups

3.3 Differences in pain and sleep quality between the two groups

3.4 Differences in patient satisfaction and nursing risk events between the two groups

4. Discussion

Declarations

References

Additional Declarations

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