The Effect of Gynaecological Laparoscopic Surgery on Cerebral Oxygenation

Abstract

During gynaecological laparoscopic surgery, alterations in cerebral blood flow and intracranial pressure are frequently reported. These changes affect cerebral perfusion pressure and thus may affect cerebral oxygenation. In this prospective study, the effect of gynaecological laparoscopic surgery on cerebral oxygenation was examined by following the changes in regional cerebral oxygen saturation (rSO 2 ). Twenty-four female patients were enrolled. The mean rSO 2 was 65.5 ± 5.4% at baseline before surgery, 60.8 ± 5.6% when the patient was placed in the Trendelenburg position, 57.1 ± 9.3% after creation of pneumoperitoneum, and 64.0 ± 7.3% after the completion of surgery. During the period of pneumoperitoneum, rSO 2 fell below 50% in two hypercapnic patients. In comparison with baseline, rSO 2 declined significantly in the Trendelenburg position. The creation of pneumoperitoneum itself did not decrease the average rSO 2 value further unless the patients were hypercapnic.

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

“…During gynecological laparoscopic procedures in the Trendelenburg position rScO 2 decreases from 66 to 57% with MAP at 80 mmHg (Lee et al, 2006). Different gas anesthesia (desflurane vs. sevoflurane) results in similar rScO 2 values and larger anesthetic depth increases rScO 2 (66 vs. 72%) (Fassoulaki et al, 2006).…”

A comparative analysis of the effects of sevoflurane and propofol on cerebral oxygenation during steep Trendelenburg position and pneumoperitoneum for robotic-assisted laparoscopic prostatectomy

“…In RALP, where ICP is already increased, it is conceivable that the CBV increase caused by volatile anesthetics could further increase ICP and in turn lower the CBF/CMRO 2 ratio and cerebral oxygenation. Supporting this hypothesis, one study showed cerebral oxygen desaturation in a steep Trendelenburg position and pneumoperitoneum with isoflurane anesthesia [4]. Propofol reduces CBF by cerebral vasoconstriction and suppresses CMRO 2 .…”

The Effect of Ventilation Strategy on Arterial and Cerebral Oxygenation During Laparoscopic Bariatric Surgery

“…However, this increase in mean airway pressure may have negative impact on hemodynamic and cerebral oxygenation, especially when the patient is positioned in reverse Trendelenburg position [7,8]. During pneumoperitoneum, regional cerebral oxygen saturation (rSO 2 ) is decreased due to increased intracranial pressure [8][9][10]. Under general anesthesia, head-up position also has been reported to decrease the rSO 2 [7].…”