Abstract Both robotic surgery and head-down tilt increase intracranial pressure by impairing venous blood outflow. Prostatectomy is commonly performed in elderly patients, who are more likely to develop postoperative cognitive disorders. Therefore, increased intracranial pressure could play an essential role in cognitive decline after surgery. We describe a case of a 69-year-old male who underwent a robotic prostatectomy. Noninvasive Brain4care™ intraoperative monitoring showed normal intracranial compliance during anesthesia induction, but it rapidly decreased after head-down tilt despite normal vital signs, low lung pressure, and adequate anesthesia depth. We conclude that there is a need for intraoperative intracranial compliance monitoring since there are major changes in cerebral compliance during surgery, which could potentially allow early identification and treatment of impaired cerebral complacency.

Abstract Background The prevalence of Substance Use Disorders (SUD) and acceptance of drug testing among anesthetists in Brazil has not been determined. Methods An internet-based survey was performed to investigate the prevalence of SUD among anesthetists in Brazil, to explore the attitudes of anesthetists regarding whether SUD jeopardizes the health of an impaired provider or their patient, and to determine the provider's perspective regarding acceptance and effectiveness of drug testing to reduce SUD. The questionnaire was distributed via social media. REDCap was utilized to capture data. A sample size of 350 to achieve a confidence level of 95% and confidence interval of 5 was estimated. Study report was based on STROBE and CHERRIES statements. Results The survey was returned from 1,295 individuals. Most individuals knew an anesthesia provider with a SUD (82.07%), while 23% admitted personal use. The most common identified substances of abuse were opioids (67.05%). Very few respondents worked in a setting that performs drug testing (n = 17, 1.33%). Most individuals believed that drug testing could improve personal safety (82.83%) or the safety of patients (85.41%). Individuals with a personal history of SUD were less likely to believe in the effectiveness of drug testing to reduce one's own risk (74.92% vs. 85.18%, p< 0.0001) or improve the safety of patients (76.27% vs. 88.13%, p< 0.001). Conclusions SUDs are common among anesthetists in Brazil. Drug testing would be accepted as a viable means to reduce the incidence although a larger study should be performed to investigate the logistical feasibility.