Abstract:
In spite of an ever increasing number of laparoscopic techniques, there
is still a lot of arguments about multiple aspects of this technique as regards the best
method for accessing the peritoneal cavity by creating pneumoperitoneum which may
have many effects on cerebral perfusion state and oxygen consumption. We conducted
this study to evaluate the effect of different levels of elevated artificial intraperitoneal
pressure on the cerebral perfusion pressure (CPP) during laparoscopic cholecystectomy.
Methodology: This prospective, randomized clinical trial enrolled 40 patients scheduled
for elective laparoscopic cholecystectomy, 20 - 59 years old, of either sex, and ASA I and
II.
After ethical approval, patients were randomly assigned into two groups to receive,
either: intraperitoneal pressure of 12 mmHg (Group PL) or a pressure of 20 mmHg
(Group PH).
Results: No significant differences in heart rate, arterial oxygen saturation and end
tidal Co2 between both groups. Mean arterial pressure and CPP were lower in Group
PH vs. Group PL at 2nd intraoperative reading. CPP at this point was lower in both
groups compared to basal value, MAP in Group PH was lower and JBP was higher
at 2nd intraoperative reading than basal value. PaO2 and cerebral oxygen extraction
ratio (COER) were lower in Group PH vs, Group PL, also PaO2 was lower in Group PH
compared to basal value at 2nd intraoperative reading.
Conclusions: During laparoscopic cholecystectomy, there is frequently reported
alterations in cerebral blood flow and intracranial pressure. These changes affect
cerebral perfusion pressure and thus may affect cerebral oxygenation.
Page(s):
68-74
DOI:
DOI not available
Published:
Journal: Anaesthesia, Pain and Intensive Care, Volume: 23, Issue: 1, Year: 2019
Keywords:
Laparoscopic cholecystectomy
,
Pneumoperitoneum
,
Intraperitoneal Pressure
,
Cerebral oxygen extraction ratio
,
Cerebral perfusion pressure