TCD Monitoring Cerebral Blood Flow On Patients Undergoing Gynecologic Laparos- Copic Surgery In The Trendelenburg Position

Objective:To monitor the change of cerebral blood flow on patients undergoing gynecological endoscopy surgery at Trendelenberg position by transcranial doppler ultrasound, and explore the change of the the metabolism of brain tissue at Trendelenberg position. Then discover the relationship between neurological complications after gynecological laparoscopic surgery and the Trendelenburg position.Methods:40 patients undergoing gynecological surgery were incorpotated in this study. After the regular general anesthesia, the internal catheter was put into the right jugular vein ball. The average blood flow velocity of middle cerebral artery (Vm), pulse index (PI), resistance index (RI) were monitored at before anesthesia induction (T1)、 after induction (T2), after pneumoperitoneum (T3), at the moment of Trendelenberg position(T4), and at 30 min later (Ti), at horizon position (T6). The cerebral perfusion pressure was calculated by the equation:CPP= MAP x Vd/Vm+14. The internal jugular venous pressure was measured at the same time. At T2 and T5,the blood from internal jugular vein ball and radial artery was drawed for blood gas analysis.The Calculating the difference of arterial to jugular bulb venous oxygen content(Da-jv02), the difference of Arterial-jugular vein blood lactic acid(Da-jvLac), he difference of Arterial-jugular vein blood carbon dioxide (Da-jvCO2)and the difference of Arterial-jugular vein blood glucose(Da-jvGlu). The grade of MMSE was measured preoperative and postoperative. The rate of adcerse reaction was recorded postoperative.Results:The Vm at T2 decreased compared with Vm at T1(P<0.05),and at T4 T5 and T6 Vm were increased significantly compared with T2, (P<0.05). At T4 and T5,PI, RI, CVP were increased compared with T2(P<0.05). The CPP was increased at T5. And the Da-jvCO2 was elevated at T5. However, the Da-jvO2 was decreased at the same time (P<0.05); The Da-jvLac and Da-jvGlu were not significant changed in this study (p>0.1). The MMSE scores was no significant difference, preoperative (28.62+1.00) and postoperative (27.22+0.42). The rate of chemosis conjunctiva was increased obviously at Trendelenberg position.Conclusion:30 min after Trendelenberg position, the cerebral blood flow is hyperperfused, and the oxygen consumption of cerebral is decreased, but there was nono brain metabolic disorders at Trendelenberg position. There is no obvious postoperative cognitive dysfunction after Trendelenberg position. The rate of chemosis conjunctiva was highly at Trendelenberg position.