Comparison of the Effects of Different Positive End-Expiratory Pressure Levels on Cerebral Oxygen Saturation With Near Infrared Spectroscopy During Laparoscopic Cholecystectomy

Abstract

Although positive end-expiratory pressure (PEEP) is commonly used to improve respiratory mechanics and oxygenation during pneumoperitoneum (PP), the effect of PEEP on cerebral homeostasis during carbon dioxide PP remains uncertain. This study investigated the changes in regional cerebral oxygen saturation (rSO2) associated with 0, 5, and 10 cm H2O PEEP during PP while undergoing laparoscopic cholecystectomy under sevoflurane anesthesia. In total, 105 patients between the ages of 18 to 60 years, scheduled to undergo laparoscopic cholecystectomy under general anesthesia, were studied. The patients were randomized, into 3 groups: group I (n=35) with no external PEEP, group II (n=35) with external PEEP of 5 cm H2O, group III (n=35) with external PEEP of 10 cm H2O. Heart rate, mean blood pressure, oxygen saturation, and rSO2 values were continuously recorded from awake status to tracheal extubation. The measurements of hemodynamic parameters were statistically similar between 3 groups (P>0.05). rSO2 values were statistically similar between 3 groups (P>0.05). We consider that both 5 and 10 cm H2O PEEP levels can be safely used during PP applied during laparoscopic surgery, without affecting hemodynamics, and without causing a decline in rSO2.