Effect Of Carbon Dioxide Pneumoperitoneum On Postoperative Cognitive Function In Female Patients Undergoing Gynecological Laparoscopy

ObjectiveTo investigate the effect of carbon dioxide pneumoperitoneum on postoperative cognitive function and the level of the serum S-100βand protein NSE in female patients undergoing gynecological laparoscopy.Methods215 ASA physical status I patients were to receive either no insufflation to do conventional abdominal surgery (n=100,Ⅰgroup) or receive abdominal insufflation to gynecological laparoscopy (n=115, II group). Anesthesia was induced with propofol (1-2 mg/kg), fentanyl (0.04 mg/kg), succinylcholine (1.5 mg/kg), and maintained with isoflurane (end-tidal concentration,1.5-2.0 vol%) in 100%oxygen. Blood pressure, Heart Rate, ETCO2, PaCO2 and MMSE were recorded lday before operation, just before operation and 1,6,24,48,72h after operation and before discharge. Serum of S-100βprotein and NSE was measured by using ELISA before the beginning of operation (or carbon dioxide pneumoperitoneum)and 1h after operation (or carbon dioxide pneumoperitoneum) at I group (n=30) or II group(n=30).ResultsThere were no significant differences between the two groups in relevant medical history or hemodynamics during hospital. PaCO2 and ETCO2 in group II 1h after operation higher that before operation (P<0.01) or higher that in group I (P<0.01). MMSE score in both groups significantly decreased at 1,6, and 24h after operation(P<0.01), return to baseline in I group at 48h after operation, in II group at 72h after operation. MMSE score significantly decreased at 1,6,24,48 and 72h after operation in II group, as compared with I group(P<0.01). Serum S-100βprotein and NSE significanly at 1h after operation increased inⅠgroup andⅡgroup, as compared baseline values (P<0.01). Serum S-100βprotein significanly increased at 1h after operation inⅡgroup, as compared I group (P<0.05), whereas NSE not. Serum S-100βprotein and MMSE score are significantly correlated inⅡgroup (y=-0.0155x+ 0.4918, y=0.8126), or inⅠgroup(y=-0.019x+0.5988,γ=0.6412). Serum NSE no correlation with the MMSE score inⅠgroup (y=-1.8077x+60.472,γ=0.4397), whereas NSE and MMSE score had significant correlation inⅡgroup(y=-1.3869x+46.986,γ= 0.7111).ConclusionsCO2 pneumoperitoneum significantly affect postoperative cognitive function in female patients undergoing gynecological laparoscopy. And MMSE score is negatively correlated with the level of the serum S-100βand NSE proteins.