Hemodynamic and Respiratory Implications of Steep Position in Robotic Pelvic Surgery: Anesthesia Management Strategies

Abstract

Background: Robotic pelvic surgery frequently requires steep Trendelenburg positioning combined with pneumoperitoneum, producing significant cardiopulmonary alterations that challenge intraoperative anesthetic management. Changes in airway pressure, lung compliance, end-tidal CO₂ (ETCO₂), venous return, and systemic vascular resistance may compromise hemodynamic stability, yet real-world practice patterns for addressing these physiological stresses remain underexplored. Objective: To evaluate anesthesia professionals’ reported experiences of hemodynamic and respiratory disturbances during steep Trendelenburg in robotic pelvic surgery and to identify commonly implemented management strategies. Methods: A descriptive cross-sectional study was conducted among 150 anesthesia professionals from tertiary hospitals performing robotic pelvic procedures. A validated structured questionnaire captured demographic characteristics, reported physiological changes, ventilation modes, fluid therapy practices, and hemodynamic interventions. Data were analyzed using descriptive statistics, χ² tests, ANOVA, and Pearson correlations with significance set at p < 0.05. Results: Moderate (48.0%) and high (33.3%) hemodynamic instability were frequently reported. Elevated airway pressures (26–35 cmH₂O) occurred in 52.7% of cases, with pressures >35 cmH₂O in 25.3%. ETCO₂ rose progressively with airway pressure (r = 0.48), while lung compliance showed inverse correlations with both airway pressure (r = –0.51) and instability (r = –0.47). Pressure-controlled ventilation (55.3%) and restrictive fluid therapy (49.3%) were preferred. Conclusion: Steep Trendelenburg positioning produces predictable cardiopulmonary stress requiring vigilant anesthetic management; pressure-controlled ventilation and conservative fluid strategies appear central to maintaining intraoperative stability.