The Effects of Different Insufflation Pressures on Cerebral Oxygen Saturation in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

A pneumoperitoneum during laparoscopic procedures has deleterious effects on cerebral perfusion and oxygenation. Our aim was to assess the effects of different insufflation pressures on cerebral oxygen saturation (rSO2) using a noninvasive INVOS Cerebral Oximeter (Somanetics Corporation, USA) system. One hundred patients scheduled for laparoscopic cholecystectomy were included and divided into two groups: a 10 mmHg pneumoperitoneum group (group I) and a 14 mmHg pneumoperitoneum group (group II). The rSO2 measurements were obtained preinsufflation, after insufflation, every 15 min after insufflation, and 10 min after desufflation. Hemodynamic variables and anesthesia and surgery times were recorded. Between the two groups, there were no statistically significant differences in terms of age, sex, weight, anesthesia times, or surgery times (p > 0.05). The hemodynamic variables were similar in the two groups (p > 0.05). The rSO2 value changed over time, with a statistically significant between-group difference (p = 0.001). The preinsufflation rSO2 value was 70.07 ± 7.73 in group I and 72.21 ± 6.58 in group II, with no significant between-group difference (p > 0.05). After insufflation, the rSO2 value decreased to 69.60 ± 7.74 in group I and 64.41 ± 6.48 in group II, and the distinction was statistically significant (p < 0.001). A high-pressure pneumoperitoneum was associated with a greater decrease in rSO2 as compared to a low-pressure pneumoperitoneum. Thus, we suggest the use of a low-pressure pneumoperitoneum in patients with central nervous system pathologies.