Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery

Abstract

BackgroundWe aimed to evaluate the effects of internal jugular vein (IJV) catheterization on intracranial pressure (ICP) and postoperative delirium (POD) during robot-assisted laparoscopic surgery by measuring the optic nerve sheath diameter (ONSD).MethodsData from a prospective single-center cohort study, conducted from October 2021 to February 2022, were used. Forty out of 80 patients scheduled for laparoscopic radical hysterectomy or prostatectomy were assigned to the group receiving IJV catheterization (Group I), and the other 40 only received peripheral venous cannulation (Group C) according to clinical need of patients. Ultrasonography of ONSDs, the proportion of regurgitation time in a cardiac cycle, and hemodynamic parameters were measured at four time points: immediately after induction of anesthesia in the supine position (T0), 30 min (T1), 60 min (T2) after orienting to the Trendelenburg position, and before returning to the supine position at the end of surgery (T3). Time to eye opening and emergence stay, POD, and QoR-15 were compared.ResultsThe ONSDs increase gradually as the surgery progressed. Group I showed a higher value of ONSD at T1 (4.72 ± 0.29 mm vs. 4.5 ± 0.33 mm, p = 0.0057) and T3 (5.65 ± 0.33 mm vs. 5.26 ± 0.31 mm, p < 0.0001). The proportions of the regurgitation time of IJVV were greater in Group I than those in Group C at T1 (14.95, 8.5%–18.9% vs. 9.6%, 0%–17.2%, p < 0.0001) and T3 (14.3, 10.6%–18.5% vs. 10.4%, 0%–16.5%, p = 0.0003). Group I had a delayed time to eye opening (10.7 ± 1.72 min vs. 13.3 ± 2.35 min, p < 0.0001) and emergence stay (32.2 ± 5.62 min vs. 39.9 ± 6.7 min, p < 0.0001). There were no significant differences in POD and QoR-15 between the two groups on day three.ConclusionIJV cannulation may not be the preferred approach in robot-assisted laparoscopic surgery as it was risk factor for IJVV regurgitation, ICP elevation, emergence delayed.

Deep neuromuscular block attenuates intra‐abdominal pressure and inflammation and improves post‐operative cognition in prostate cancer patients following robotic‐assisted radical prostatectomy

“…31 Furthermore, a prospective single-centre cohort study showed that internal jugular vein catheterisation in robot-assisted surgeries elevated intracerebral pressure. 32 Apart from the abovementioned, increased CO 2 crossing the blood-brain barrier can induce consecutive intra-operative hypercarbia and acidosis, leading to cerebral hypoxaemia, 33,34 which is associated with the release of vascular factors and actuate-venous short circuit opening, eventually resulting in cognitive impairment such as increased sleepiness, confusion, and loss of memory ( [35][36][37][38]. Although these studies provide some insight on the effects of CO 2 on brain functions, much work is still needed to clarify the cellular mechanism underlying the correlation between CO 2 absorption and cognition in the RALRP in our future studies.…”

Comparison of combined intravenous and inhalation anesthesia and total intravenous anesthesia in laparoscopic surgery and the identification of predictive factors influencing the delayed recovery of neurocognitive function

“…The establishment of pneumoperitoneum and the administration of anesthetic drugs during laparoscopic surgery can have an impact on the hemodynamic stability of patients and the smooth recovery of postoperative cognitive function ( 16 ). The use of anesthetic drugs can lead to a higher stimulation response, thereby significantly affecting cognitive function ( 17 , 18 ). This trial tries to compare the doses of analgesics and muscle relaxants administered per unit of time under two different anesthesia methods, as well as evaluate the postoperative recovery quality system.…”