Anesthetic Considerations for Contemporary Radical Prostatectomy

  • Jerome F. O’HaraJr.
  • David Whalley
Part of the Current Clinical Urology book series (CCU)


Anesthetic management for patients presenting for radical prostatectomy can be challenging. The different anesthetic techniques utilized in caring for these patients are influenced by whether an open or laparoscopic surgical approach is planned. Surgeon expertise, anesthetic technique, and method of postoperative pain control can affect the patient’s postoperative course. We review the anesthesia-related literature specific to this surgery and describe how our anesthetic management of these patients has evolved over the last decade.


Laparoscopic Cholecystectomy Radical Prostatectomy Epidural Analgesia Epidural Anesthesia Minimally Invasive Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Shir Y, Frank SM, Brendler CB, Raja SN. Postoperative morbidity is similar in patients anesthetized with epidural and general anesthesia for radical prostatectomy. Urology 1994; 44: 232–236.PubMedCrossRefGoogle Scholar
  2. 2.
    Frank E, Sood OP, Torjman M, et al. Postoperative epidural analgesia following radical retropubic prostatectomy: outcome assessment. J Surg Oncol 1998; 67: 117–120.PubMedCrossRefGoogle Scholar
  3. 3.
    Shir Y, Raja SN, Frank SM, et al. Intraoperative blood loss during radical retropubic prostatectomy: epidural versus general anesthesia. Urology 1995; 45: 993–999.PubMedCrossRefGoogle Scholar
  4. 4.
    Malhotra V. A comparision of epidural anesthesia, general anesthesia, and combined epidural general anesthesia for radical prostatectomy. Anesthesiology 1994; 81 (3A): A973.Google Scholar
  5. 5.
    Stevens RA, Mikat-Stevens M, Flanigan R, et al. Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy? Urology 1998; 52: 213.PubMedCrossRefGoogle Scholar
  6. 6.
    Shir Y, Raja SN, Frank SM. The effect of epidural versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing radical prostatectomy. Anesthesiology 1994; 80: 49–56.PubMedCrossRefGoogle Scholar
  7. 7.
    Gottschalk A, Smith DS, Jobes DR, et al. Preemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial. JAMA 1988; 279: 1076–1082.CrossRefGoogle Scholar
  8. 8.
    Steptoe PC. Laparoscopy in Gynaecology. ES Livingstone, London, 1967.Google Scholar
  9. 9.
    Marshall RL, Jebson PJR, Davie IT, Scott DB. Circulatory effects of carbon dioxide insufflation of the peritoneal cavity for laparoscopy. Br J Anaesth 1972; 44: 680–684.PubMedCrossRefGoogle Scholar
  10. 10.
    Smith I, Benzie RJ, Gordon NLM, Kelman GR, Swapp GH. Cardiovascular effect of peritoneal insufflation of carbon dioxide for laparoscopy. BMJ 1971; 3: 410–411.PubMedCrossRefGoogle Scholar
  11. 11.
    Kelman GR, Swapp GH, Benzie RJ, Gordon NL. Cardiac output and arterial blood-gas tension during laparoscopy. Br J Anaesth 1972; 44: 1155–1162.PubMedCrossRefGoogle Scholar
  12. 12.
    Gannedahl P, Odeberg S, Brodin L, Sollevi A. Effects of posture and pneumoperitoneum during anaesthesia on the indices of left ventricular filling. Acta Anaesthesiol Scand 1996; 40: 160–166.PubMedCrossRefGoogle Scholar
  13. 13.
    Harris SN, Ballantyne GH, Luther MA, Perrino AC. Alterations of cardiovascular performance during laparoscopic colectomy: a combined hemodynamic and echocardiographic analysis. Anesth Analg 1996; 83: 482–487.PubMedGoogle Scholar
  14. 14.
    Fujise K, Shingu K, Matsumoto S, et al. The effects of the lateral position on cardiopulmonary function during laparoscopic urological surgery. Anesth Analg 1998; 87: 925–930.PubMedGoogle Scholar
  15. 15.
    Morison DH, Riggs JRA. Cardiovascular collapse in laparoscopy. Can Med Assoc J 1974; 111: 433–437.PubMedGoogle Scholar
  16. 16.
    Wahba RWM, Beique F, Kleiman SF. Cardiopulmonary function and laparoscopic cholecystectomy. Can J Anaesth 1995; 42: 51–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Bardoczky GI, Engleman E, Levarlet M, Simon P. Ventilatory effects of pneumoperitoneum monitored with continuous spirometry. Anaesthesia 1993; 48: 309–311.PubMedCrossRefGoogle Scholar
  18. 18.
    Scott DB, Slawson KB. Respiratory effects of prolonged Trendelenburg position. Br J Anaesth 1968; 40: 103–107.PubMedCrossRefGoogle Scholar
  19. 19.
    Wolf JS, Monk TG, McDougall EM, et al. The extraperitoneal approach and subcutaneous emphysema are associated with greater absorption of carbon dioxide during laparoscopic renal surgery. J Urol 1995; 154: 959–963.PubMedCrossRefGoogle Scholar
  20. 20.
    Ng CS, Gill IS, Sung GT, et al. Retroperitoneoscopic surgery is not associated with increased carbon dioxide absorption. J Urol 1999; 162: 1268–1272.PubMedCrossRefGoogle Scholar
  21. 21.
    Joris JL, Noirot DP, Legrand MJ, et al. Hemodynamic changes during laparoscopic cholecystectomy. Anesth Analg 1993; 76: 1067–1071.PubMedCrossRefGoogle Scholar
  22. 22.
    Dhoste K, Lacoste L, Karayan J, et al. Haemodynamic and ventilatory changes during laparoscopic cholecystectomy in elderly ASA III patients. Can J Anaesth 1996; 43: 783–788.PubMedCrossRefGoogle Scholar
  23. 23.
    Tan PL, Lee TL, Tweed WA. Carbon dioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth 1992; 39: 677–681.PubMedCrossRefGoogle Scholar
  24. 24.
    Wittgen CM, Andrus CH, Fitzgerald SD, et al. Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 1991; 126: 997–1001.PubMedCrossRefGoogle Scholar
  25. 25.
    Hanley ES. Anesthesia for laparoscopic surgery. Surg Clin North Am 1992; 72: 1014–1018.Google Scholar
  26. 26.
    Azurin DJ, LS, Cwik JC, et al. The efficacy of epidural anesthesia for endoscopic preperitoneal herniorrhaphy. J Laparosc Surg 1996; 6: 369–373.CrossRefGoogle Scholar
  27. 27.
    Michaloliakou C, Chung F, Sharma S. Preoperative multimodal analgesia facilitates recovery after ambulatory laparoscopic cholecystectomy. Anesth Analg 1996; 82: 244–251.Google Scholar
  28. 28.
    Yogendran Y, Asokumar B, Cheng DCH, et al. A prospective randomized double-blinded study of the effect of intravenous fluid therapy on adverse outcomes on outpatient surgery. Anesth Analg 1995; 80: 682–686.PubMedGoogle Scholar
  29. 29.
    Henzi I, Walder B, Tramer MR. Dexamethasone for the prevention of postoperative nausea and vomiting: a quantitative systematic review. Anesth Analg 2000; 90: 186–194.PubMedCrossRefGoogle Scholar
  30. 30.
    Sprung J, O’Hara JF, Gill IS, et al. Anesthetic aspects of laparoscopic and open adrenalectomy for pheochromocytoma. Urology 2000; 55: 339–343.PubMedCrossRefGoogle Scholar
  31. 31.
    Hynson JM, Sessler DI. Intraoperative warming therapies: a comparison of three devices. J Clin Anesth 1992; 4: 194–199.PubMedCrossRefGoogle Scholar
  32. 32.
    Chun TY, Martin S, Lepor H. Preoperative recombinant human erythropoietin injection versus preoperative autologous blood donation in patients undergoing radical retropubic prostatectomy. Urology 1997; 50: 727.PubMedCrossRefGoogle Scholar
  33. 33.
    Monk TG, Goodnough LT, Brecher ME, et al. A prospective randomized comparison of three blood conservation strategies for radical prostatectomy. Anesthesiology 1999; 91: 24–33.PubMedCrossRefGoogle Scholar
  34. 34.
    O’Hara JF Jr, Sprung J, Klein EA, et al. Use of preoperative autologous blood donation in patients undergoing radical retropubic prostatectomy. Urology 1999; 54: 130–134.PubMedCrossRefGoogle Scholar
  35. 35.
    Goh M, Kleer CG, Kielczewski P, et al. Autologous blood donation prior to anatomical radical retropubic prostatectomy: is it necessary? Urology 1997; 49: 569–573.PubMedCrossRefGoogle Scholar
  36. 36.
    Das A, Strup S, Canfield S, et al. Utilization of autologous blood donation during radical retropubic prostatectomy. Tech Urol 1998; 4: 131–135.PubMedGoogle Scholar
  37. 37.
    Goldschlag B, Afzal N, Carter HB, et al. Is preoperative donation of autologous blood rational for radical retropubic prostatectomy? J Urol 2000; 164: 1968–1972.PubMedCrossRefGoogle Scholar
  38. 38.
    Koch MO, Smith JA Jr. Blood loss during radical retropubic prostatectomy: is preoperative autologous blood donation indicated? J Urol 1996; 156: 1077–1079.PubMedCrossRefGoogle Scholar
  39. 39.
    Goad JR, Eastham JA, Fitzgerald KB, et al. Radical retropubic prostatectomy: limited benefit of autologous blood donation. J Urol 1995; 154: 2103–2109.PubMedCrossRefGoogle Scholar
  40. 40.
    Goodnough LM, Grishaber JE, Birkmeyer JD, et al. Efficacy and cost-effectiveness of autologous blood predeposit in patients undergoing radical prostatectomy procedures. Urology 1994; 44: 226–231.PubMedCrossRefGoogle Scholar
  41. 41.
    Terada N, Arai Y, Matsuta Y, et al. Acute normovolemic hemodilution for radical prostatectomy: can it replace preoperative autologous blood transfusion? Int J Urol 2001; 8: 149–152.PubMedCrossRefGoogle Scholar
  42. 42.
    Monk TG, Goodnough LT, Birkmeyer JD, et al. Acute normovolemic hemodilution is a cost-effective alternative to preoperative autologous blood donation by patients undergoing radical retropubic prostatectomy. Transfusion 1995; 35: 559–565.PubMedCrossRefGoogle Scholar
  43. 43.
    Gray CL, Amling CL, Polston GR, et al. Intraoperative cell salvage in radical retropubic prostatectomy. Urology 2001; 58: 740–745.PubMedCrossRefGoogle Scholar
  44. 44.
    Thomas MJ. Infected and malignant fields are an absolute contraindication to intraoperative cell salvage: fact or fiction? Transfus Med 1999; 9: 269–278.PubMedCrossRefGoogle Scholar
  45. 45.
    Boldt J, Weber A, Mailer K, et al. Acute normovolaemic haemodilution vs controlled hypotension for reducing the use of allogeneic blood in patients undergoing radical prostatectomy. Br J Anaesth 1999; 82: 170–174.PubMedCrossRefGoogle Scholar
  46. 46.
    Barre C, Pocholle P, Chauveau P. Minimal blood loss in patients undergoing radical retropubic prostatectomy. World J Surg 2002; 26: 1094–1098.PubMedCrossRefGoogle Scholar
  47. 47.
    Strup SE, Gudziak M, Mulholland SG, et al. The effect of intermittent pneumatic compression devices on intraoperative blood loss during radical prostatectomy and radical cystectomy. J Urol 1993; 150: 1176–1178.PubMedGoogle Scholar
  48. 48.
    Groudine SB, Fisher HA. Intravenous lidocaine speeds the return of bowel function, decreases postoperative pain, and shortens hospital stay in patients undergoing radical retropubic prostatectomy. Anesth Analg 1998; 86: 235–239.PubMedGoogle Scholar
  49. 49.
    Allaire PH, Messick JM Jr, Oesterling JE, et al. A prospective randomized comparison of epidural infusion of fentanyl and intravenous administration of morphine by patient-controlled analgesia after radical retropubic prostatectomy. Mayo Clin Proc 1992; 67: 1031–1041.PubMedCrossRefGoogle Scholar
  50. 50.
    Grass JA, Sakima NT, Valley M, et al. Assessment of ketorolac as an adjuvant to fentanyl patient-controlled epidural analgesia after radical retropubic prostatectomy. Anesthesiology 1993; 78: 642–648.PubMedCrossRefGoogle Scholar
  51. 51.
    See WA, Fuller JR, Toner ML. An outcome study of patient-controlled morphine analgesia, with or without ketorolac, following radical retropubic prostatectomy. J Urol 1995; 154: 1429–1432.PubMedCrossRefGoogle Scholar
  52. 52.
    Klein EA, Grass JA, Calabrese DA, Kay RA, Sargeant W, O’Hara JF. Maintaining quality of care and patient satisfaction with radical prostatectomy in the era of cost containment. Urology 1996; 269–276.Google Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Jerome F. O’HaraJr.
  • David Whalley

There are no affiliations available

Personalised recommendations