Evaluation of the relationship between intraoperative cerebral oxygen saturation and postoperative cognitive functions in laparoscopic hysterectomy surgery

Yıl 2023, , 121 - 125, 31.01.2023

Resul Yılmaz , Hasan Çekdemir , Emine Türen Demir , Şule Arıcan , Gülçin Hacıbeyoğlu , Ruhiye Reisli , Sema Tuncer

https://doi.org/10.16899/jcm.1217548

Öz

Objective: Laparoscopic surgery has become more popular than traditional open surgery because it is less invasive, provides faster recovery, and provides better cosmetic success. This procedure requires insufflation of an inert gas into the peritoneal cavity. This may be an increase in arterial CO2, changes in cerebral blood flow, an increase in intra-abdominal pressure (IAP), a decrease in cardiac output. The primary outcome of this study is to show the effect of IAP levels on cerebral oxygen saturation (COS) in patients who underwent laparoscopic total abdominal hysterectomy, and the secondary outcome is to reveal the relationship between IAP and COS and the recovery of postoperative cognitive functions.
Material and Method: Demographic data of the cases were recorded and mini-mental test (MMT) was applied to evaluate the preoperative cognitive functions of the cases before surgery. COS monitoring were performed with standard anesthesia procedure for all patients. The MMT was repeated after the surgery.
Results: A total of 40 female patients were included in the study. Those with IAP level 12 and below were defined as Group Low-Pressure, and those above 12 were defined as Group High-Pressure. There was no statistical difference between the anesthesia times and recovery times of the two groups. While there was no statistical difference in the preoperative MMT evaluation, it was found to be significantly lower in Group H in the postoperative MMT evaluation.
Conclusion: In this study, we evaluated the effect of intraoperative IAP levels on intraoperative COS. It is seen that high IAP level does not have a negative effect on COS. In addition, this study has evidence that high IAP affects postoperative cognitive functions. In intraoperative management for TLH surgery, we recommend maintaining the IAP level at the lowest appropriate pressure that does not impair surgical comfort.

Anahtar Kelimeler

cerebral oxygen saturation, cognitive functions, laparoscopic hysterectomy, general anesthesia

Laparaskopik histerektomi cerrahisinde intraoperatif serebral oksijen saturasyonu ile postoperatif kognitif fonksiyonların ilişkisinin değerlendirilmesi

Öz

Amaç: Laparoskopik cerrahi, daha az invaziv olması, daha hızlı iyileşme sağlaması ve daha iyi kozmetik başarı sağlaması nedeniyle geleneksel açık cerrahiden daha popüler hale gelmiştir. Bu prosedür, inert bir gazın periton boşluğuna üflenmesini gerektirir. Bu, arteriyel karbondioksit basıncında bir artış, serebral kan akışında değişiklikler, karın içi basıncında (İAB) bir artış, kalp debisinde bir azalma olabilir. Bu çalışmanın birincil sonucu, laparoskopik total abdominal histerektomi uygulanan hastalarda İAB düzeylerinin serebral oksijen satürasyonu (SOS) üzerindeki etkisini göstermek ve ikincil sonuç, İAB ve SOS ile postoperatif bilişsel işlevlerin iyileşmesi arasındaki ilişkiyi ortaya koymaktır.
Gereç ve Yöntem: Olguların demografik verileri kaydedildi ve olgulara ameliyat öncesi kognitif fonksiyonlarını değerlendirmek için ameliyat öncesi mini-mental test (MMT) uygulandı. Tüm hastalar için standart anestezi prosedürü ile SOS monitörizasyonu yapıldı. MMT ameliyattan sonra tekrarlandı.
Bulgular: Çalışmaya toplam 40 kadın hasta dahil edildi. IAB seviyesi 12 ve altında olanlar Grup Düşük-Basınç (Grup L), 12'nin üzerinde olanlar Grup Yüksek-Basınç (Grup H) olarak tanımlandı. İki grubun anestezi süreleri ve derlenme süreleri arasında istatistiksel fark yoktu. Preoperatif MMT değerlendirmesinde istatistiksel olarak fark bulunmazken, postoperatif MMT değerlendirmesinde Grup H'de anlamlı olarak düşük bulundu.
Sonuç: Bu çalışmada intraoperatif İAB düzeylerinin intraoperatif SOS'a etkisini değerlendirdik. Yüksek İAB düzeyinin SOS'a olumsuz etkisinin olmadığı görüldü. Ayrıca bu çalışmada yüksek İAB'nin ameliyat sonrası kognitif fonksiyonları etkilediğine dair kanıtlar var. TLH cerrahisi için intraoperatif yönetimde, İAB seviyesinin cerrahi konforu bozmayan uygun en düşük basınçta tutulmasını öneririz.

Anahtar Kelimeler

cerebral oxygen saturation, cognitive functions, laparoscopic hysterectomy

Kaynakça

• 1. Gibson CL, Johnson GA, Fisher R, Stewart A, Giles G,Johnson JO,et al. Changes in cerebral oximetry during peritoneal insufflation for laparoscopic procedures. J Minim Access Surg 2006; 2: 67-72.
• 2. Pasch T, Zalunardo M. Intraoperatives Monitoring. Notwendiges, sinnvolles und überflüssiges. Anaesthetist 2000; 49 (1): 2-6.
• 3. Hoppenstein D, Zohar E, Ramaty E, Shabat S. The effects of general vs spinal anesthesia on frontal cerebral oxygen saturation in geriatric patients undergoing emergency surgical fixation of the neck of the femur. J Clin Anesth 2005; 17 (6): 431-8.
• 4. Carron E. Positive end-expiratory pressure in obese patients during general anaesthesia. The role of intraabdominal pressure. Br J Anaesth 2018; 120 (2): 409-10.
• 5. Han S, Moon H, Oh Y, Lee J. Cerebral oxygenation during gynecologic laparoscopic surgery. Anesthesiology 2003; 99: A277.
• 6. Pappa M, Theodosiadis N, Tsounis A, Sarafis P. Pathogenesis And Treatment of Post-Operative Cognitive Dysfunction. Electronic Physician ( ISSN:2008-5842). February 2017, Volume:9, Issue: 2, Pages:3768-3775.
• 7. Somprakit P, Lertakyamanee J, Satraratanamai C, Wanicksamban S, Silapadech A, Chainchop P, et al. Mental state change after general and regional anesthesia in adults and elderly patients, a randomized clinical trial. J Med Assoc Thai. 2002;85(Suppl 3):S875–83.
• 8. Slater JP, Guarino T, Stack J, Vinod K, Bustami RT, Brown JM, et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann Thorac Surg. 2009 Jan;87(1):36-44; discussion 44-5. doi: 10.1016/j.athoracsur.2008.08.070. PMID: 19101265.
• 9. Tang L, Kazan R, Taddei R, Zaouter C, Cyr S, Hemmerling TM. Reduced cerebral oxygen saturation during thoracic surgery predicts early postoperative cognitive dysfunction. Br J Anaesth. 2012 Apr;108(4):623-9. doi: 10.1093/bja/aer501.
• 10. Turan E. Laparoskopik Bariatrik Cerrahinin. Serebral Oksijenizasyon Üzerine Etkisi. Turkiye Klinikleri J Med Sci. 2019;39(2):135-43.
• 11. Ay N. The retrospective evaluation of cerebral oxygenation monitorization in patients undergoing gynecologic laparoscopy. Ege Journal of Medicine 2019; 58 (3): 239-245
• 12. Uzzo RG,Bilsky M, Mininberg DT, Poppas DP. Laparoscopic surgery in children with ventriculo peritoneal shunts: effect of pneumoperitoneum on intracranial pressure–preliminary experience. Urology 1997; 49:753-7
• 13. Moncure M, Salem R, Moncure K, Testaiuti M, Marburger R, Ye X, et al: Central nervous system metabolic and physiologic effects of laparoscopy. Am Surg1999; 65:168–172.
• 14. Abe K, Hashimoto N, Taniguchi A, Yoshiya I. Middle cerebral artery blood flow velocity during laparoscopic surgery in head-down position. Surg Laparosc Endosc1998;8:1–4.
• 15. Huettemann E, Terborg C, Sakka SG, Petrat G, Schier F, Reinhart K, et al. Preserved CO(2) reactivity andincrease in middle cerebral arterial blood flowvelocity during laparoscopic surgery in children. Anesth Analg 2002; 94:25– 258.
• 16. Magnaes B: Body position and cerebrospinal fluid pressure. Par 1:clinical studies on the effect of rapid postural changes. J Neurosurg1976; 44:687 – 697.
• 17. Lovell AT, Marshall AC, Elwell CE, Smith M, Goldston JC. Changes in cerebral bloodvolume with changes in position in awake andanesthetized subjects. Anesth Analg 2000; 90:372–376.
• 18. Loeppky JA, Hirshfield DW, Eldridge MW. The effects of head-down tilt on carotid blood flow and pulmonary gas exchange. Aviat Space Environ Med 1987; 58:637–644
• 19. Hu Z, Zhao G, Xiao Z, Chen X, Zhong C, Yang J. Different responses of cerebral vessels to –30 degrees head-dow tilt in humans. Aviat Space Environ Med 1999; 70:674680.
• 20. Goetz CG. Textbook of Clinical Neurology,2nd edn. Chicago: Elsevier, 2003; pp511–529.
• 21. Citerio G, Vascotto E, Villa F, Celotti S, Pesenti A. Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med 2001:29;1466–1471
• 23. Lauerman MH, Stein DM. Multicompartment management of patients with severe traumatic brain injury. Curr Opin Anaesthesiol 2014:27;219–224
• 22. Scalea TM, Bochicchio GV, Habashi N, McCunn M, Shih D, McQuillan K, et al. Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome. J Trauma 2007:62;647–656
• 24. Depauw PRAM, Groen RJM, Van Loon J, Peul WC, Malbrain MLNG, De Waele JJ. The significance of intra-abdominal pressure in neurosurgery and neurological diseases: a narrative review and a conceptual proposal. Acta Neurochir (Wien). 2019 May;161(5):855-864.
• 25. Kirkpatrick AW, De Waele JJ, De Laet I, De Keulenaer BL, D’Amours S, Björck M, Balogh ZJ, et al. WSACS–the abdominal compartment society. A society dedicated to the study of the physiology and pathophysiology of the abdominal compartment and its interactions with all organ systems. Anaesthesiol Intensive Ther 2015:47;191–194
• 26. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, et al. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 2001:344;395– 402.
• 27. Canet J, Raeder J, Rasmussen LS, Enlund M, Kuipers HM, Hanning CD, et al. Cognitive dysfunction after minor surgery in the elderly. Acta Anaesthesiol Scand 2003;47:1204–10.
• 28. Park CG, Jung WS, Park HY, Kim HW, Kwak HJ, Jo YY. Comparison of the Effects of Normocapnia and Mild Hypercapnia on the Optic Nerve Sheath Diameter and Regional Cerebral Oxygen Saturation in Patients Undergoing Gynecological Laparoscopy with Total Intravenous Anesthesia. J. Clin. Med. 2021;10:4707