The retrospective evaluation of cerebral oxygenation monitorization in patients undergoing gynecologic laparoscopy
Öz
Aim: Several systems and cerebral oxygen saturation are affected by
Trendelenburg position and pneumoperitoneum created by carbon dioxide
insufflation. Alterations in cerebral oxygen saturation (rSO2) during laparoscopic
surgery and PEEP administration are measured by cerebral oximetry (NIRS). By using
NIRS, depression in rSO2tissue hypoxia and can be detected earlier,
as soon as is affected. In this study, we aimed to investigate retrospectively
the effects of different PEEP levels on cerebral oxygenation and hemodynamic
effects of patients undergoing gynecologic laparoscopy.
Materials and Methods: The files of 69 patients undergoing gynecologic laparoscopy were
analyzed. Eight 8 PEEPs in 22 patients, 6 PEEPs in 23 patients and 4 PEEPs in
24 patients had been administrated. The groups were named as Group 8, Group 6
and Group 4. Non-invasive arterial blood pressure (ABP), heart rate (HR),
oxygen saturation, end-tidal carbon dioxide (ETCO2) and rSO2 were recorded in all
patients.
Results: After the patient was put into Trendelenburg position and after
intraperitoneal insufflations were given, ABP and HR were significantly reduced
in all groups. After intubation, in all groups ETCO2 was increased
significantly, but the changes in SpO2
and rSO2 were not statistically significant. There was a significant positive
correlation between ETCO2 and rSO2 in all groups (p<0.05).
Conclusion: We think that during laparoscopic surgery in
Trendelenburg position, administration of 8 PEEPs, 6 PEEPs and 4 PEEPs in did
not affect cerebral oxygenation, ETCO2 increase due to CO2 insufflation and occurrence
of pneumoperitoneum can affect the rSO2 values.
Anahtar Kelimeler
Gynecologic laparoscopy pneumoperitoneum Trendelenburg position.
Kaynakça
- Pasch T, Zalunardo M. Intraoperatives Monitoring. Notwendiges, sinnvolles und überflüssiges. Anaesthetist 2000; 49 (1): 2-6.
- Hoppenstein D, Zohar E, Ramaty E, Shabat S. The effects of general vs spinal anesthesia on frontal cerebral oxygen saturation in geriatric patients undergoing emergency surgical fixation of the neck of the femur. J Clin Anesth 2005; 17 (6): 431-8.
- Carron E. Positive end-expiratory pressure in obese patients during general anaesthesia. The role of intraabdominal pressure. Br J Anaesth 2018; 120 (2): 409-10. Luecke T, Pelosi P. Positive end-expiratory pressure and cardiac output. Critical Care 2005; 9 (6): 607-21.
- Çiçek F, Ün C, Kılcı O ve ark. The effects of 10 cmH 2 O positive end-expiratory pressure on arterial oxygenation, respiratory mechanics and hemodynamic parameters in laparoscopic cholecystectomy operations. J Clin Exp Invest 2014; 5 (3): 397-402.
- Yong J, Hibbert P, Runciman WB, Coventry BJ. Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery. Int J Qual Health Care 2015; 27 (6): 473-8.
- Takahata O, Kunisawa T, Nagashima M, et al. Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position. Acta Anaesthesiol Scand 2007; 51 (6): 687-92.
- Kim JY, Shin CS, Kim HS, et al. Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy. Surg Endosc 2010; 24 (5): 1099-103.
- Han S, Moon H, Oh Y, Lee J. Cerebral oxygenation during gynecologic laparoscopic surgery. Anesthesiology 2003; 99: A277.
- Mavrocordatos, P, Bissonnette, B, Ravussin, P. Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: Preliminary results. J Neurosurg Anesthesiol 2000; 12 (1): 10-4.
- Vegh T, Szatmari S, Juhasz M, et al. One-lung ventilation does not result in cerebral desaturation during application of lung protective strategy if normocapnia is maintained. Acta Physiol Hung 2013; 100 (2): 163-72.
- Halverson A, Buchanan R, Jacobs L, et al. Evaluation of mechanism of increased intracranial pressure with insufflation. Surgical Endoscopy 1998; 12 (3): 266-9.
- Park EY, Koo BN, Min KT, Nam SH. The effect of pneumoperitonium in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand 2009; 53 (7): 895-9.
- Muench E, Bauhuf C, Roth H, et al. Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation. Crit Care Med 2005; 33 (10): 2367-72.
- Jo YY, Lee JY, Lee MG, Kwak HJ. Effects of high positive end-expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitonium in the Trendelenburg position. Anaesthesia 2013; 68 (9): 938-43.
Jinekolojik laparoskopi uygulanan hastaların serebral oksijenasyon takiplerinin retrospektif olarak incelenmesi
Öz
Amaç: Laparaskopik cerrahide uygulanan Trendelenburg
pozisyonu ve karbondioksit insüflasyonuyla oluşturulan pnömoperiton, serebral
oksijen satürasyonu (rSO2) ile pek çok sistemi etkilemektedir. Laparaskopik
cerrahi sırasında serebral oksijen satürasyonunda oluşan değişiklikler, serebral
oksimetre (NIRS) ile ölçülmektedir. NIRS kullanılarak, rSO2 düşüklüğü ve doku
hipoksisi erkenden tespit edilebilmektedir. Bu çalışmada, jinekolojik
laparoskopi olgularında uyguladığımız farklı pozitif end ekspiryum basıncı (PEEP) düzeylerinin serebral oksijenasyon ve
hastaların hemodinamik verileri üzerine olan etkilerini retrospektif olarak
araştırmayı planladık.
Gereç ve Yöntem: Jinekolojik laparoskopi uygulanmış, 69
hastanın dosyaları incelendi. 22 hastaya 8 PEEP, 23 hastaya 6 PEEP ve 24 hastaya 4 PEEP uygulanmış olduğu belirlendi. Bu hastaların oluşturduğu gruplara
sırasıyla Grup 8, Grup 6 ve Grup 4 isimleri verildi. Non-invaziv ortalama kan
basıncı (OKB), kalp hızı (KAH), oksijen satürasyonu (SpO2), end-tidal
karbondioksit (ETCO2) ve rSO2 verilerini kaydedildi.
Bulgular: Hasta Trendelenburg pozisyonuna alındıktan ve
intraperitoneal insuflasyon uygulandıktan sonraki KAH ve OKB’nin tüm gruplarda
belirgin olarak azaldığı görüldü. Üç grupta da entübasyon sonrası ETCO2
değerine göre, sonrasında meydana gelen tüm ölçümler istatistiksel olarak anlamlı
artmış (p<0.05), SpO2
ve rSO2değerlerinde meydana gelen değişimler ise istatistiksel
olarak anlamlı olmamıştır. Tüm gruplardaki ETCO2 ile rSO2 arasında pozitif
yönde anlamlı korelasyon vardı.
Sonuç: Trendelenburg pozisyonundaki laparoskopik cerrahilerde; 8 PEEP,
6 PEEP ve 4 PEEP uygulanmasının serebral oksijenasyonu etkilemediğini, CO2
insüflasyonuyla pnömoperiton oluşturulmasıyla meydana gelen ETCO2 artışın rSO2değerlerini
etkilediğini düşünmekteyiz.
Anahtar Kelimeler
Jinekolojik laparoskopi pnömoperiton Trendelenburg pozisyonu.
Kaynakça
- Pasch T, Zalunardo M. Intraoperatives Monitoring. Notwendiges, sinnvolles und überflüssiges. Anaesthetist 2000; 49 (1): 2-6.
- Hoppenstein D, Zohar E, Ramaty E, Shabat S. The effects of general vs spinal anesthesia on frontal cerebral oxygen saturation in geriatric patients undergoing emergency surgical fixation of the neck of the femur. J Clin Anesth 2005; 17 (6): 431-8.
- Carron E. Positive end-expiratory pressure in obese patients during general anaesthesia. The role of intraabdominal pressure. Br J Anaesth 2018; 120 (2): 409-10. Luecke T, Pelosi P. Positive end-expiratory pressure and cardiac output. Critical Care 2005; 9 (6): 607-21.
- Çiçek F, Ün C, Kılcı O ve ark. The effects of 10 cmH 2 O positive end-expiratory pressure on arterial oxygenation, respiratory mechanics and hemodynamic parameters in laparoscopic cholecystectomy operations. J Clin Exp Invest 2014; 5 (3): 397-402.
- Yong J, Hibbert P, Runciman WB, Coventry BJ. Bradycardia as an early warning sign for cardiac arrest during routine laparoscopic surgery. Int J Qual Health Care 2015; 27 (6): 473-8.
- Takahata O, Kunisawa T, Nagashima M, et al. Effect of age on pulmonary gas exchange during laparoscopy in the Trendelenburg lithotomy position. Acta Anaesthesiol Scand 2007; 51 (6): 687-92.
- Kim JY, Shin CS, Kim HS, et al. Positive end-expiratory pressure in pressure-controlled ventilation improves ventilatory and oxygenation parameters during laparoscopic cholecystectomy. Surg Endosc 2010; 24 (5): 1099-103.
- Han S, Moon H, Oh Y, Lee J. Cerebral oxygenation during gynecologic laparoscopic surgery. Anesthesiology 2003; 99: A277.
- Mavrocordatos, P, Bissonnette, B, Ravussin, P. Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: Preliminary results. J Neurosurg Anesthesiol 2000; 12 (1): 10-4.
- Vegh T, Szatmari S, Juhasz M, et al. One-lung ventilation does not result in cerebral desaturation during application of lung protective strategy if normocapnia is maintained. Acta Physiol Hung 2013; 100 (2): 163-72.
- Halverson A, Buchanan R, Jacobs L, et al. Evaluation of mechanism of increased intracranial pressure with insufflation. Surgical Endoscopy 1998; 12 (3): 266-9.
- Park EY, Koo BN, Min KT, Nam SH. The effect of pneumoperitonium in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand 2009; 53 (7): 895-9.
- Muench E, Bauhuf C, Roth H, et al. Effects of positive end-expiratory pressure on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation. Crit Care Med 2005; 33 (10): 2367-72.
- Jo YY, Lee JY, Lee MG, Kwak HJ. Effects of high positive end-expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitonium in the Trendelenburg position. Anaesthesia 2013; 68 (9): 938-43.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 18 Mayıs 2018 |
| Yayımlandığı Sayı | Yıl 2019 |