Hey guys,

I do a decent number of robot cases, mostly prostates. I was told three things when I started doing them:

1.)Don't give long acting narcotic, post-op pain is minimal.
2.) Don't use N20, like with any laproscopic case
3.) Run them super dry or their eyes and airways will swell shut and they will stroke out.

Since I had trained (as an SRNA) with the CRNAs who had given me this advice (and I had seen how their patient's wake up and act intraop), I immediately disregarded the first two and have a great results so far (n=25-30 cases) with up-front morphine and N20.

However, I'm still leery about going against the 3rd caveat. I'm especially concerned about the risk of stroke by increasing central venous pressure in this extreme position.

We do them at 29 degrees which is max t-berg for my bed. The patients are bowel prepped and tend to act "dry" intraop IME. The PACU nurses have told that they have to pour in fluids postop to get these patient to make urine. During the case the urine is mixed with the blood and irrigation so you never really know what the UOP is.....

So, for a HEALTHY patient (normal heart and lungs), for a 3-5hr cases, how much IVFs would you guys consider excessive? Some of my colleagues are giving less than 1L. I'm on the other extreme and have been giving up to 3L for the longer cases with more blood loss (and bigger patients), but I usually shoot in the last liter at the end when the patient is flat. I have noticed any swelling around the eyes (unlike long prone cases).

Any comments, thoughts, experiences would be appreciated!