Evaluation of cerebral blood flow during laparoscopic cholecystectomy using transcranial doppler ultrasonography

ABSTRACT

Laparoscopic procedures are common nowadays. They have many advantages, however, they carry special risks in certain cases due to the associated cardiac and pulmonary dysfunction as well as CO2 retention. The aim of this work is to evaluate the effect of one of these procedures; namely laparoscopic cholecystectomy; on cerebral blood flow [CBP] using transcranial Doppler [TCD] ultrasonography to determine the right middle cerebral artery velocity [MCAV] which is proved to correlate well with CBF. Sixteen patients classified as American Society of Anaesthesiologists [ASA] physical status I, and II were included in the study. Their heart rate [HR], mean arterial pressure [MAP], end-tidal carbon dioxide concentration [PETCO2], arterial carbon dioxide tension [PaCO2], and MCAV were recorded before CO2 insufflation, then 10, 20, 30 and 40 minutes after insufflation, and again 10 minutes after peritoneal deflation. Significant increase [P<0.01] in MCAV in all the recorded values was found. This increase was attributed mainly to the accompanying rise in PaCO2. The present study concluded that CBF was increased significantly in laparoscopic procedures utilizing C02 as the insufflation gas. ft is recommended to avoid pneumoperitonium or to use it with extreme caution in patients with suspected or documented intracranial injuries due to the potential for significant increase in intracranial pressure [ICP] and alterations in cerebral perfusion pressure [CPP]