Effects of Haemodynamic Changes Caused by Different Pneumoperitoneum Pressures on Cerebral Oxygenation in Laparoscopic Cholecystectomy: Prospective Randomised Controlled Trial.

ABSTRACT

OBJECTIVE: To evaluate the role of different pneumoperitoneum pressure ranges on cerebral oxygenation. STUDY DESIGN: Prospective, randomised controlled trial. Place and Duration of the Study Karadeniz Technical University, Turkiye, from January to September 2020. METHODOLOGY: Seventy patients (aged 18-65 years, ASA I-IIII) scheduled for laparoscopic cholecystectomy were divided into two groups; low pressure (LP, 10-12 mmHg) and high pressure (HP, 13-15 mmHg). The heart rate, peripheral oxygen saturation, systolic, diastolic, and mean arterial pressure, BIS, end-tidal carbon dioxide, and left and right regional cerebral oxygen saturation (rSO2) were recorded during induction, at the beginning, and after 5, 10, 15, 30, 60, and 90th minutes of pneumoperitoneum, after the surgical and anaesthesia procedures. RESULTS: The findings did not demonstrate a significant difference between the haemodynamic parameters of the groups. However, there were differences (fifth [p=0.022], fifteenth minutes [p=0.035], at the end [p=0038] of pneumoperitoneum in right rSO2, and similarly at the end [p=0.038] of pneumoperitoneum in left rSO2 between mean variation of rSO2 when compared to the baseline; cerebral oxygenation was better preserved in LP. While no patient had more than 20% rSO2 reduction in LP, a total of three patients had cerebral desaturation in HP. CONCLUSION: Although <15 mmHg pressure for pneumoperitoneum was usually well-tolerated by patients, it had been observed that cerebral oxygenation may be affected with this range. The pathophysiological effects of pneumoperitoneum and possible consequences of this situation should be considered while performing laparoscopy. KEY WORDS Cerebrovascular circulation, Haemodynamics, Laparoscopic cholecystectomy, Near- infrared spectroscopy, Pneumoperitoneum.