Before the induction of anesthesia, all patients were monitored with electrocardiography, pulse oximetry, non-invasive blood pressure, end-tidal carbon dioxide concentration, and the bispectral index. General anesthesia was induced with 4–5 mg/kg thiopental sodium or 1.5–2 mg/kg propofol and 0.5–0.8 mg/kg rocuronium, and maintained with 1–4 vol% sevoflurane and 50% oxygen. Arterial catheterization was performed to continuously monitor the arterial blood pressure, and central venous catheterization was performed through the internal jugular vein. Tidal volume was adjusted to 8–10 mL per ideal body weight, and the respiratory rate was adjusted to maintain an end-tidal carbon dioxide concentration of 35–40 cmH2O. Positive end-expiratory pressure and the recruitment maneuver were not applied in any patient. The concentration of sevoflurane was adjusted to maintain a bispectral index of 40–60. Mean arterial blood pressure was maintained above 65 mmHg, with fluid administration and the intermittent use of inotropic agents or vasopressors (e.g. ephedrine, phenylephrine, or norepinephrine). For fluid administration, both crystalloids such as lactated Ringer’s solution or plasma solution A (CJ Pharmaceutical, Seoul, Republic of Korea) and colloids such as 6% hydroxyethyl starch or 5% albumin were used. Transfusion of red blood cells was performed when hemoglobin concentration was < 8 g/dL. Neuromuscular blockade was reversed with a neostigmine-glycopyrrolate mixture or sugammadex at the discretion of the anesthesiologist. Intravenous patient-controlled analgesia with fentanyl was used for postoperative pain management.
Radical cystectomy and pelvic lymphadenectomy were performed according to the standard technique used at our center.19 (link),20 (link) Standard or extended pelvic lymph node dissection was performed at the discretion of urologic surgeons. Standard pelvic lymph node dissection included the hypogastric, distal common iliac, external iliac, obturator, and perivesical lymph nodes. Extended lymph node dissection included the lymph node to the extent of the inferior vena cava, distal aorta, and proximal common iliac artery. A subsequent urinary diversion with an ileal neobladder or ileal conduit was performed at the discretion of urologic surgeons. Five highly experienced urologic surgeons performed all the operations.
Radical cystectomy and pelvic lymphadenectomy were performed according to the standard technique used at our center.19 (link),20 (link) Standard or extended pelvic lymph node dissection was performed at the discretion of urologic surgeons. Standard pelvic lymph node dissection included the hypogastric, distal common iliac, external iliac, obturator, and perivesical lymph nodes. Extended lymph node dissection included the lymph node to the extent of the inferior vena cava, distal aorta, and proximal common iliac artery. A subsequent urinary diversion with an ileal neobladder or ileal conduit was performed at the discretion of urologic surgeons. Five highly experienced urologic surgeons performed all the operations.
