Effect Of Modified Chest-up Trendelenburg Position On Cerebral Function In Elderly Patients With Laparoscopy

Part I:Effect of modified chest-up Trendelenburg position on ICP and cerebral circulation in elderly patients with laparoscopic gynecologic surgery.ObjectiveTo observe the change of ICP and cerebral blood flow of elderly patients with laparoscopic gynecological surgery in modified chest-up Trendelenburg position by ultrasound.MethodsPatients were selected from Changhai Hospital Affiliated to Second Military Medical University and Wuxi People’s Hospital Affiliated to Nanjing Medical University from January 2014 to October 2015.Forty ASA I orⅡpatients aged ≥60 yr and BMI 19-24,scheduled for elective gynecological surgery,were randomly divided into 2 groups(n=20 each):patients placed in chest-up position by using custom made posture cushions in the study group(group M)and patients in conventional Trendelenburg position in the control group(group T).We monitored ONSD,blood velocity time average peak(TAP)of middle cerebral artery,pulse index(PI),resistance index(RI)at 5min after regular general anesthesia induction in supine position(T1),after pneumoperitoneum in modified Trendelenburg position or Trendelenburg position immediately(T2),after 30 min(T3),after 60 min(T4),after 90 min(T5),at 15 min after deflation in horizon position(T6).SPSS 19.0 statistical software was used for analysis.Measurement data as mean ± standard deviation(x±s)was compared with analysis of variance between the groups,compared with analysis of variance before and after pneumoperitoneum in the groups.P<0.05 was considered statistically significant difference.P<0.01 was considered highly statistically significant difference.ResultsCompared with that at T1,TAP and PI at T2 ~ 5 significantly increased in both groups,ONSD and RI at T4,5 significantly increased in group M,ONSD and RI at T3~6 and PI at T6 significantly increased in group T(P<0.05).Compared with that in group T,ONSD and RI at T3 and T6 significantly decreased,TAP and PI at T2 significantly decreased in group M(P<0.05).ConclusionModified chest-up Trendelenburg position delays ICP and CBF increased significantly,earlier accelerates their recovery to the normal range after deflation and ensures safety of prolonged laparoscopy surgery in elderly patients.Part II:Effect of modified chest-up Trendelenburgposition on cerebral oxygen metabolism and early postoperative cognitive function in elderly patients with laparoscopic radical resection of colorectal carcinoma.ObjectiveTo observe the change of cerebral oxygen metabolism and early postoperative cognitive function in elderly patients with laparoscopic radical resection of colorectal carcinoma in modified chest-up Trendelenburg position.MethodsPatients were selected from Changhai Hospital Affiliated to Second Military Medical University and Wuxi People’s Hospital Affiliated to Nanjing Medical University from January 2014 to October 2015.Eighty ASA I orⅡpatients aged ≥60 yr and BMI 19-25,scheduled for elective laparoscopic radical resection of colorectal carcinoma,were randomly divided into 2 groups(n=40 each):patients placed in chest-up position by using custom made posture cushions in group M and patients in conventional Trendelenburg position in group T.Blood samples were taken from radial artery and jugular bulb,simultaneously at 5 min after regular general anesthesia induction in supine position(T1),after pneumoperitoneum in modified Trendelenburg position or Trendelenburg position immediately(T2),at 30 min(T3),60min(T4),90 min(T5)after pneumoperitoneum,at 15 min after deflation in horizon position(T6)respectively.The values of blood gas,blood glucose,lactate and MAP were recorded.Ca-jvDO2 and Da-jvglu were calculated.Cognitive function was assessed by mini-mental state examination at 24 h before anesthesia and 6、24、48 h and 72 h after anesthesia.SPSS 19.0 software was used for statistical analysis.Measurement data as mean ± standard deviation(x±s)was compared with variance of analysis between the groups,compared with analysis of variance before and after pneumoperitoneum in the groups.P<0.05 was considered statistically significant difference.P<0.01 was considered highly statistically significant difference.ResultsCompared with that at T1,PaCO2 at T3~6,PjvO2 at T3~5 and SjvO2 at T4~5 significantly increased in both groups,MAP at T2 significantly decreased in both groups,MAP at T4~6 significantly increased in group M;MAP at T3~6,SjvO2 % at T6 and Lacjv at T5 significantly increased and Ca-jvDO2 at T5 significantly decreased in group T(P<0.05).Compared with that in group T,Ca-jvDO2 at T5 was not significantly decreased,MAP at T4~6,SjvO2 and Lacjv at T5 were not significantly increased,Da-jvglu was not significant different before and after pneumoperitoneum and PaCO2 at T6 significantly decreased in group M(P<0.05).Compared with that in group T,MMSE scores at 6、24h after anesthesia were significantly higher in group M.Compared with that pre-anesthesia,MMSE scores decreased significantly at 2h after anesthesia in both groups(P<0.01).ConclusionModified chest-up Trendelenburg position in the late stage of pneumoperitoneum alleviates the cerebral oxygen supply and demand imbalance,significantly decreases the incidence of cognitive decline in 24 h after anesthesia and ensures safety of prolonged laparoscopy surgery in elderly patients.