Effects of Hemodynamic Changes Caused by Different Pneumoperitoneum Pressures on Cerebral Oxygenation in Laparoscopic Cholecystectomy

Thesis Type: Expertise In Medicine

Institution Of The Thesis: Karadeniz Technical University, Tıp Fakültesi, Cerrahi Tıp, Turkey

Approval Date: 2021

Thesis Language: Turkish


Supervisor: Sedat Saylan


Aim: The purpose of this research was to compare the effects of hemodynamic changes on cerebral oxygenation of the patients who were operated on two different pneumoperitoneum pressure intervals, which were categorised as low pressure interval (10-12 mmHg) and high pressure interval (13-15 mmHg), with cerebral oximetry. Materials and Methods: The study was conducted on 70 patients between the ages of 18 and 65 randomised prospectively and were included in ASA I, II, III scoring by applying elective laparoscopic cholecystectomy in reverse Trendelenburg position. The post-study data analysis was comprised of the data of 60 patients. The patients included in the study were first divided into two groups before operation according to their pneumoperitoneum pressure levels, low pressure (10-12 mmHg) and high pressure (13-15 mmHg) groups, respectively. On all patients, %50/ %50 oxygen/ air mixture and %2 sevoflurane gas mixture was used in the maintenance of anesthesia. During the surgery, analgeasia was provided by remifentanil infusion. The heart rate, peripheral oxygen saturation, systolic and diastolic arterial pressure, mean arterial pressure, BIS value, end-tidal carbon dioxide value, left and right regional cerebral oxygen saturation (rSO2) values of all patients were recorded during pre-anesthesia and post-anesthesia induction, at the beginning of pneumoperitoneum and after 5th, 10th, 15th, 30th, 60th and 90th minutes pneumoperitoneum was formed. These values were also recorded after the surgical operation and anesthesia. Results: The findings did not demonstrate statistically significant difference between the groups when their hemodynamic parameters (heart rate, mean arterial pressure, systolic and diastolic arterial pressure, peripheral oxygen saturation and end-tidal carbondioxide pressure) were compared (p>0,05). However, statistically significant difference was noted between their mean variation values of right rSO2 values when compared to the basal values that is after the fifth minute of pneumoperitoneum (p=0,022), fifteenth minute of pneumoperitoneum (p=0,035) and at the end of pneumoperitoneum (p=0,038). Also statistically significant difference was found between the mean variation of left rSO₂ values from baseline according to the groups, at the end of pneumoperitoneum (p=0.038). When right cerebral oxygen saturation values of the two groups were compared according to the basal value, none of the patients had more than %20 drop from the beginning basal value during the operation in the group on which low pressure was applied. Amongst the group on which high pressure was applied, however, two patients had more than %20 drop during pneumoperitoneum and three patients had more than %20 drop during cerebral oxygen saturation after the surgery in their values. Conclusion: When the variation in the hemodynamic parameters of two patient groups who were categorized on the basis of low and high insufflation pressure in conducting pneumoperitoneum, and on whom laparoscopic cholecystectomy was performed, no statistically significant difference was recorded. However, there were statistically significant difference between the groups according to the mean variation values of their cerebral oxygen saturation values compared to the basal values. This study concluded that in the group on which low pressure was applied, the cerebral oxygenation was maintained better than the other group. Key Words: Laparoscopic cholecystectomy, pneumoperitoneum, hemodynamics, cerebrovascular circulation, near infrared spectroscopy