Effects of CO₂ Pneumoperitoneum on the Cognitive Function of Patients Undergoing Gynecologic Laparoscopy

Abstract

Aim: To evaluate the effects of CO₂ pneumoperitoneum during gynecologic laparoscopy on patients' postoperative cognitive function. Methods: This prospective clinical study included 225 adult female patients with American Society of Anesthesiologists physical status I or II. Patients underwent conventional open surgery (group I, n = 115) or gynecologic laparoscopy using abdominal insufflation with CO₂ to an intra-abdominal pressure of 15 mm Hg (group II, n = 110). Serum S100β and neuron-specific enolase (NSE) concentrations were measured, both immediately before surgery and before the patient awoke after surgery. The Mini-Mental State Examination (MMSE) was administered 1 day before surgery as well as 1, 6, 12, 24 and 72 h after surgery and before discharge. Results: MMSE scores were significantly lower relative to baseline at 1, 6 and 12 h post surgery, but returned to baseline by 48 h (group I) or 72 h (group II) post surgery. One hour after surgery, S100β serum levels were higher in group II than in group I (p < 0.05). NSE levels did not differ between the groups. In group II, the MMSE score significantly correlated with serum S100β or NSE concentrations. Conclusion: CO₂ pneumoperitoneum influences postoperative cognitive function in patients undergoing gynecologic laparoscopy.

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.…”

Partial amniotic carbon dioxide insufflation for fetal surgery

“…Hypercapnic acidosis causes vasodilation of cerebral vessels thereby increasing cerebral blood flow and intracranial pressure . In adults, hypercapnia decreases cerebral oxygen metabolism, alters cerebral neurotransmission, and increases markers of neuronal injury . Studies of permissive hypercapnia in ventilated premature and very low birth weight infants show progressively impaired cerebral blood flow autoregulation at PaCO 2 levels above 45 mmHg and an increasing risk of intraventricular hemorrhage with increasing PaCO 2 .…”

“…33 In adults, hypercapnia decreases cerebral oxygen metabolism, alters cerebral neurotransmission, and increases markers of neuronal injury. [56][57][58] Studies of permissive hypercapnia in ventilated premature and very low birth weight infants show progressively impaired cerebral blood flow autoregulation at PaCO 2 levels above 45 mmHg and an increasing risk of intraventricular hemorrhage with increasing PaCO 2 . 67,68 Conversely, a more recent large randomized control trial using permissive hypercapnia in extremely low birth weight infants (PHELBI study) did not confirm an increased risk of intraventricular hemorrhage.…”

Safety and efficacy of low-dose esketamine in laparoscopic cholecystectomy: a prospective, double-blind randomized controlled trial

“…However, the procedure necessitates the creation of a pneumoperitoneum, which can adversely affect the patient’s respiratory, circulatory, and neurological systems. If not properly managed, it can lead to cognitive impairment [ 2 ]. Postoperative cognitive dysfunction (POCD), a condition that can manifest in the weeks following non-vascular surgery, has been reported in 10–54% of cases.…”