Işık ALPER, Ali ÖZGÜN, Asuman SARGIN, Semra KARAMAN, İlkben GÜNÜŞEN, Fatma Zekiye AŞKAR

The relationship between the Trendelenburg position and cerebral hypoxia inpatients who have undergone robot-assisted hysterectomy and prostatectomy

Background/aim: This study aimed to evaluate the relationship between the Trendelenburg position and cerebral hypoxia in robotassisted hysterectomy and prostatectomy. Materials and methods: A standardized mini-mental state examination was administered to 50 patients enrolled in the study 1 h before and after surgery. Near infrared spectroscopy (NIRS) values and hemodynamic and respiratory parameters were recorded after induction of anesthesia (baseline) and once every 20 min in the Trendelenburg position and supine positions. The relationship between the development of cerebral desaturation and the patient s position was examined. Results: For all patients, the baseline mean cerebral oxygen saturation (RSO2 ) on the right and left were 70.5 ± 7.3% and 70.6 ± 6.7%, respectively. Right RSO2values at 20 min and 60 min in the Trendelenburg position decreased significantly, but they increased at 120 min. A significant positive correlation was found between right RSO2and EtCO2in the supine period following surgery, and between left RSO2and EtCO2at 60 min in the Trendelenburg and supine positions. The relationship between NIRS values and cognitive dysfunction was not significant. Conclusion: We found that cerebral saturation decreases as age increases, and cerebral desaturation may occur owing to the Trendelenburg position. There was no correlation between patients cognitive function and NIRS values.

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1. Han S, Moon H, Oh Y, Lee J. Cerebral oxygenation during gynecologic laparoscopic surgery. Anesthesiology 2003; 99: A277.
2. Marimon GA, Dockery WK, Sheridan MJ, Agarwal S. Nearinfrared spectroscopy cerebral and somatic (renal) oxygen saturation correlation to continuous venous oxygen saturation via intravenous oximetry catheter. J Crit Care 2012; 27: 314. e13-314.e18.
3. Zheng Y, Villamayor AJ, Merritt W, Pustavoitau A, Latif A, Bhambani R, Frank S, Gurakar A, Singer A, Cameron A et al. Continuous cerebral blood flow autoregulation monitoring in patients undergoing liver transplantation. Neurocrit Care 2012; 17: 77-84.
4. Kalmar AF, Dewaele F, Foubert L, Hendrickx JF, Heeremans EH, Struys MMRF, Absalom A. Cerebral haemodynamic physiology during steep Trendelenburg position and CO2 pneumoperitoneum. Br J Anaesth 2012; 108: 478-484.
5. Pandey R, Garg R, Darlong V, Punj J, Chandralekha, Kumar A. Unpredicted neurological complications after robotic laparoscopic radical cystectomy and ileal conduit formation in steep Trendelenburg position: two case reports. Acta Anaesthesiol Belg 2010; 61: 163-166.
6. Magnaes B. Body position and cerebrospinal fluid pressure. Part 1: Clinical studies on the effect of rapid postural changes. J Neurosurg 1976; 44: 687-697.
7. Hu Z, Zhao G, Xiao Z, Chen X, Zhong C, Yang J. Different responses of cerebral vessels to-30 degrees head-down tilt in humans. Aviat Space Environ Med 1999; 70: 674-680.
8. Harvey L, Edmonds HL Jr, Ganzel BL, Austin EHIII. Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 2004; 8: 147-166.
9. Fujiwara Y, Iwahori Y, Shibata Y, Asakura Y, Akashi M. Regional cerebral oxygen saturation and EEG changes caused by beach chair position. Anesthesiology 2008; 1099: A907.
10. Huettemann E, Terborg C, Sakka SG, Petrat G, Schier F, Reinhart K. Preserved CO2 reactivity and increase in middle cerebral arterial blood flow velocity during laparoscopic surgery in children. Anesth Analg 2002; 94: 255-258.
11. Fujii Y, Tanaka H, Tsuruoka S, Toyooka H, Amaha K. Middle cerebral arterial blood flow velocity increases during laparoscopic cholecystectomy. Anesth Analg 1994; 78: 80-83.
12. Smith AL, Wollman H. Cerebral blood flow and metabolism. Anesthesiol 1972; 36: 378-396.
13. Kolb JC, Ainslie PN, Ide K, Poulin MJ. Protocol to measure acute cerebrovascular and ventilatory responses to isocapnic hypoxia in humans. Respir Physiol Neurobiol 2004; 141: 191- 199.
14. Fujii Y, Tanaka H, Tsuruoka S, Toyooka H, Amaha K. Middle cerebral artery blood flow velocity during laparoscopic surgery in head-down position. Surg Laparosc Endosc 1998; 8: 1-4.
15. Denault A, Deschamps A, Murkin JM. A proposed algorhythm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth 2007; 11: 274- 281.
16. Papadimitriou LS, Livanios SH, Moka EG, Demesticha TD, Papadimitriou JD. Cerebral blood flow velocity alterations, under two different carbon dioxide management strategies, during sevoflurane anesthesia in gynecological laparoscopic surgery. Neurol Res 2003; 25: 361-369.
17. Cho H, Nemoto EM, Yonas H, Balzer J, Sclabassi RJ. Cerebral monitoring by means of oximetry and somatosensory evoked potentials during carotid endarterectomy. J Neurosurg 1998; 89: 533-538.
18. OMalley C, Cunningham AJ. Physiologic changes during laparoscopy. Anesthesiol Clin North Am 2001; 1: 1-18.
19. Schramm P, Treiber AH, Berres M, Pestel G, Engelhard K, Werner C, Closhen D. Time course of cerebrovascular autoregulation during extreme Trendelenburg position for robotic-assisted prostatic surgery. Anaesthesia 2014; 69: 58-63.
20. Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Montanini S. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a prospective cohort study. Eur J Anaesthesiol 2007; 24: 59-65.
21. Park EY, Koo BN, Min KT, Nam SH. The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand 2009; 53: 895- 899.
22. Hung YC, Huang CJ, Kuok CH, Chien CC, Hsu YWI. The effect of hemodynamic changes induced by propofol induction on cerebral oxygenation. J Clin Anesth 2005; 17: 353-357.
23. Tamara-Trafidlo T, Gaszynki T, Gaszynki W. İntraoperative monitoring of cerebral NIRS oximetry leads to better postoperative cognitive performance: a pilot study. Int J Surg 2015; 16: 23-30.
24. Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Kogler VM. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after bypass surgery: a randomized, prospective study. Eur J Cardiothorac Surg 2015; 47: 447-454.
25. Chen J, Yan J, Han X. Dexmedetomidine may benefit cognitive function after laparoscopic cholecystectomy in elderly patients. Exp Ther Med 2013; 5: 489-494.
26. Newman S, Stygall J, Hirani S, Shacfi S, Maze M. Postoperative cognitive dysfunction after noncardiac surgery: a systematic review. Anesthesiology 2007; 106: 572-590.
27. Jo YY, Kim JY, Lee MG, Lee SG, Kwak HJ. Changes in cerebral oxygen saturation and early postoperative cognitive function after laparoscopic gastrectomy: a comparison with conventional open surgery. Korean J Anesthesiol 2016; 69: 44- 50.