A Study on the Effects of CO2 Pneumoperitoneum and Trendelenburg position on Arterial Acid-Base Balance and Middle Cerebral Artery Hemodynamics in Gynecologic Laparoscopic Surgery / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: The purpose of this study was to identify arterial acid-balance and cerebral hemodynamics in patients undergoing gynecologic laparoscopic operations according to induction of CO2 pneumoperitoneum and Trendelenburg position. METHODS: Twenty patients without cardiopulmonary disease undergoing various laparoscopic pelvic surgeries were resulted in data of arterial blood and hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pCO2, pH, pO2, middle cerebral blood flow velocity (MCABFV), pulsatile index (PI), resistance index (RI). Under the standardized setting of general anesthesia, arterial blood and hemodynamic parameters were determined in supine position (base line) before CO2 insufflation, and 15 minutes, 30 minutes, 45 minutes in Trendelenburg position after CO2 insufflation, and 10 minutes in supine position after CO2 defflation. RESULTS: The arterial BP, pCO2 and MCABFV increased significantly in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. PI decreased significantly compared with control in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. RI decreased significantly as compared with control in Trendelenburg position after CO2 insufflation and persisted even after 10 minutes in supine position after CO2 defflation. CONCLUSION: Intraoperative arterial blood gas analysis is required in patients with high risk of hypercarbia during gynecologic laparoscopic surgery, and clinicians should anticipate an increase in cerebral blood flow and decrease in cerebral vascular resistance after CO2 pneumoperitoneum and Trendelenburg position, and gynecologic laparoscopy may be safe in view point of cerebral hemodynamics.