MUSTAFA AZİZOĞLU, Süleyman MEMİŞ, Funda BARGU, İlkay SAYDERE, Handan BİRBİÇER, Gülhan TEMEL OREKİCİ

Cerebral oxygenation and its relation with blood gases and haemodynamic parameters in laparoscopic cholecystectomy with 5 cm $H_2O$ PEEP

Objective: Pneumoperitoneum application during abdominal surgeries can have negative effects on haemodynamic and respiratory parameters. Cerebral oxygenation level is influenced by many factors; the partial arterial $CO_2$ pressure (Pa$CO_2$) level is the main determinant factor among them. We investigated the effects of $CO_2$ insufflation and the head-up position on haemodynamic parameters and cerebral oxygenation levels during laparoscopic cholecystectomy with the application of 5cm $H_2O$ positive end–expiratory pressure (PEEP). Materials and Methods: Forty patients, between 18-65 of age, with an ASA physical status of I–II were included in the study. Following anaesthesia induction, 5 cm $H_2O$ PEEP was applied and $CO_2$ was insufflated into the abdominal space. Patients were operated in the 15° head-up position. Results: Mean cardiac output was observed to be significantly higher after desufflation (5.80 ± 1.39) in comparison to the initial values prior to the pneumoperitoneum application (5.08 ± 0.95), (p< 0.05). There was no significant change in other haemodynamic parameters or cerebral oxygenation levels. Pa$CO_2$ and end-tidal $CO_2$ (Et$CO_2$) levels significantly increased during the pneumoperitoneum period (PaCO2 = 33.37 ± 4.97, 36.77 ± 3.91, and 39.35 ± 3.51 mmHg, and Et$CO_2$ = 31.52 ± 2.80, 33.95 ± 3.38, and 35.72 ± 2.92 mm Hg; before, at 5 and 20 min after insufflation respectively; p < 0.05). Conclusion: Application of 5 cm $H_2O$ PEEP does not improve the cerebral oxygenation but may contribute to preservation of baseline values with stable haemodynamic status after insufflation during laparoscopic cholecystectomy. Fluid administering strategy and use of opioids are important factors to achieve stable haemodynamic condition. In addition, mildly increased Pa$CO_2$ levels may contribute to preserving cerebral oxygenation.

5 cm $H_2O$ PEEP UYGULANAN LAPAROSKOPİK KOLESİSTEKTOMİLERDE SEREBRAL OKSİJENASYONUN KAN GAZLARI VE HEMODİNAMİ İLE İLİŞKİS

Amaç: Pnömoperitonyumun hemodinamik ve solunumsal parametreler üzerine olumsuz etkileri olabilmektedir. Serebral oksijenasyon, parsiyel arteriyel $CO_2$ basıncı (Pa$CO_24) temel belirleyici olmakla birlikte birçok faktörden etkilenir. Bu çalışmada 5 cm $H_2O$ pozitif end ekspiratuar basınç (PEEP) uygulaması ile laparoskopik kolesistektomilerde $CO_2$ insüflasyonu ve baş yukarı pozisyonun hemodinamik parametreler ve serebral oksijenasyon üzerine etkilerini araştırdık. Gereç ve Yöntem: Anestezi risk grubu ASA I - II olan, 18-65 yaş arası 40 hasta çalışmaya dâhil edildi. Anestezi indüksiyonunun ardından, 5 cm $H_2O$ PEEP uygulandı ve abdomen $CO_2$ ile insufle edildi. Hastalar 15° baş pozisyonunda opere edildi. Bulgular: Pnömoperitonyum peryodu ile karşılaştırılınca, desüflasyon sonrası dönemde kardiyak debinin (CO) arttığı gözlendi (sırasıyla 5,08 ± 0,95 ve 5,80 ± 1,39; p

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