The Effect Of Trendelenburg Position On Cerebral Oxygen Saturation During Laparoscopic Surgery

Objective:To research the effect of Trendelenburg position on cerebral oxygen saturation during laparoscopic surgery.Methods: There are 120 female patients undergoing laparoscopic myomectomy and laparoscopic cholecystectomy enrolled in this study from November 2014 to November 2016,60 cases in each group,with ASA class I~II,aged30~60,pneumoperitoneum time less than 90 min,BMI 18~24 kg/m2,were selected.And the exclusion criteria were preoperative pulmonary dysfunction,liver and renal dysfunction,and cardiovascular disease;trauma or an operation at the position where monitored within three months;electrolytedisturbance(potassium,calcium,magnesium,etc);communication barriers;history of alcoholismor drug abuse and so on.Arrivals immediately(T0),after induction of anesthesia(T1),after pneumoperitoneum 5min(T2),after pneumoperitoneum 10min(T3),after pneumoperitoneum 15min(T4),after the lifting of pneumoperitoneum 5min(T5),after the lifting of pneumoperitoneum 10min(T6)and after the lifting of pneumoperitoneum 15min(T7)were recorded.The indexes were compared between the two groups: MAP,HR,PECO2,rSO2 values and the time of pneumoperitoneum.Patients were randomly divided into two groups:A group received by laparoscopic myomectomy,C group received by laparoscopic cholecystectomy.Results: A,C group of patients after induction of anesthesia MAP,HR compared to the level of entry into the room decreased.MAP was increased at each time point after the start of pneumoperitoneum and maintained at a high level.The MAP decreased in all groups after the removal of pneumoperitoneum,gradually restored to the level of entry into the room(P<0.05).There was no significant difference between HR in each group of pneumoperitoneum(P<0.05),and there was no significant difference between the two groups(P>0.05),and maintained at a high level.There was no significant difference in MAP and HR between the two groups(P>0.05).The levels of PECO2 in group A and C were significantly higher than the levels of after induction of anesthesia(P<0.05).The PECO2 of group A was significantly higher than that of group C at each time points after pneumoperitoneum(P<0.05).The rSO2 in each group was significantly higher than that after induction of anesthesia,and the levels of rSO2 were significantly increased during pneumoperitoneum(P<0.05).After pneumoperitoneum the rSO2 become declining trend,but still higher than the level of entry into the room(P<0.05),and the levels of rSO2 in group A were significantly higher than those in group C(P<0.05).Conclusion: 1.The use of noninvasive cerebral oxygen saturation monitor can effectively help determine the surgical period of local brain tissue metabolic situation.2.Carbon dioxide pneumoperitoneum can cause excessive perfusion of the brain and there may be brain cells hypoxia.3.head low foot can cause cerebral blood circulation is limited,increased intracranial pressure,resulting in cerebral oxygen supply and demand imbalance.