5 cm $H_2O$ PEEP UYGULANAN LAPAROSKOPİK KOLESİSTEKTOMİLERDE SEREBRAL OKSİJENASYONUN KAN GAZLARI VE HEMODİNAMİ İLE İLİŞKİS

Cerebral oxygenation and its relation with blood gases and haemodynamic parameters in laparoscopic cholecystectomy with 5 cm $H_2O$ PEEP

Mustafa AZİZOĞLU, Süleyman MEMİŞ, Handan BİRBİÇER, Gülhan OREKİCİ TEMEL, Funda BARGU, İlkay SAYDERE

Özet

Amaç: Pnömoperitonyumun hemodinamik ve solunumsal parametreler üzerine olumsuz etkileri olabilmektedir. Serebral oksijenasyon, parsiyel arteriyel $CO_2$ basıncı (Pa$CO_24) temel belirleyici olmakla birlikte birçok faktörden etkilenir. Bu çalışmada 5 cm $H_2O$ pozitif end ekspiratuar basınç (PEEP) uygulaması ile laparoskopik kolesistektomilerde $CO_2$ insüflasyonu ve baş yukarı pozisyonun hemodinamik parametreler ve serebral oksijenasyon üzerine etkilerini araştırdık. Gereç ve Yöntem: Anestezi risk grubu ASA I - II olan, 18-65 yaş arası 40 hasta çalışmaya dâhil edildi. Anestezi indüksiyonunun ardından, 5 cm $H_2O$ PEEP uygulandı ve abdomen $CO_2$ ile insufle edildi. Hastalar 15° baş pozisyonunda opere edildi. Bulgular: Pnömoperitonyum peryodu ile karşılaştırılınca, desüflasyon sonrası dönemde kardiyak debinin (CO) arttığı gözlendi (sırasıyla 5,08 ± 0,95 ve 5,80 ± 1,39; p

Abstract

Objective: Pneumoperitoneum application during abdominal surgeries can havenegative effects on haemodynamic and respiratory parameters. Cerebraloxygenation level is influenced by many factors; the partial arterial $CO_2$ pressure(Pa$CO_2$) level is the main determinant factor among them. We investigated theeffects of $CO_2$ insufflation and the head-up position on haemodynamicparameters and cerebral oxygenation levels during laparoscopiccholecystectomy with the application of 5cm $H_2O$ positive end–expiratorypressure (PEEP).Materials and Methods: Forty patients, between 18-65 of age, with an ASAphysical status of I–II were included in the study. Following anaesthesiainduction, 5 cm $H_2O$ PEEP was applied and $CO_2$ was insufflated into theabdominal space. Patients were operated in the 15° head-up position.Results: Mean cardiac output was observed to be significantly higher afterdesufflation (5.80 ± 1.39) in comparison to the initial values prior to thepneumoperitoneum application (5.08 ± 0.95), (p< 0.05). There was no significantchange in other haemodynamic parameters or cerebral oxygenation levels.Pa$CO_2$ and end-tidal $CO_2$ (Et$CO_2$) levels significantly increased during thepneumoperitoneum period (PaCO2 = 33.37 ± 4.97, 36.77 ± 3.91, and 39.35 ± 3.51mmHg, and Et$CO_2$ = 31.52 ± 2.80, 33.95 ± 3.38, and 35.72 ± 2.92 mm Hg; before, at5 and 20 min after insufflation respectively; p < 0.05).Conclusion: Application of 5 cm $H_2O$ PEEP does not improve the cerebraloxygenation but may contribute to preservation of baseline values with stablehaemodynamic status after insufflation during laparoscopic cholecystectomy.Fluid administering strategy and use of opioids are important factors to achievestable haemodynamic condition. In addition, mildly increased Pa$CO_2$ levels maycontribute to preserving cerebral oxygenation.