The effects of hemodynamic changes on cerebral oxygenation caused by pneumoperitoneum with different insufflation flows in laparoscopic cholecystectomy

Purpose: In our study, we aimed to compare the interaction between hemodynamic changes and cerebral oxygenation using cerebral oximetry in two different patient groups in which pneumoperitoneum was created with low flow (10 Lt/min) and high flow (40 Lt/min). Materials and Method: The study was conducted as a prospective randomized study in a total of 69 patients, aged 18-65 years and included in the ASA I-III classification, who underwent laparoscopic cholecystectomy in reverse Trendelenburg under elective conditions. Data of 61 patients were evaluated in the study. The patients were randomly divided into two groups as low flow (10lt/min) and high flow (40 lt/min) based on the pre-operative insufflation flow rates. 50%/50% oxygen/air mixture and 2% sevoflurane were used in all patients during anesthesia. Remifentanyl infusion was provided throughout the operation. Standard monitoring (heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, end-tidal carbon dioxide values, peripheral oxygen saturation with electrography) and right and left cerebral oxygen saturation (rSO2) monitoring were applied to the patient, and the values were recorded right before the induction, after the induction, onset of pneumoperitoneum, at minutes 1, 3, 5, 10, 15, 30, 60, and 90 of pneumoperitoneum, at the end of the surgical procedure, and at the end of anesthesia. Findings: No statistically significant difference was found between the low flow (DAK) and high flow (YAK) groups in age, gender, height, body weight, BMI means, ASA classification, presence of chronic disease, and smoking history (p>0.05). The differences between the DAK and YAK groups were not statistically significant in hemodynamic (heart rate, systolic, mean and diastolic arterial pressures, end-tidal carbon dioxide values, and peripheral oxygen saturation) parameters (p>0.05). When the changes in left rSO₂ values at all measurement times in terms of the onset of pneumoperitoneum values were compared in the DAK and YAK groups, there was no statistically significant difference between the changes in the groups at different times, except for minute 3 after pneumoperitoneum (p>0.05). All of those who had 20% or more decrease at minute 3 after pneumoperitoneum compared to the beginning of pneumoperitoneum were in the YAK group and statistically significant (p=0.044). 4 patients had a decrease more than 20% in cerebral oxygen saturation during pneumoperitoneum in the YAK group. Conclusion: When the within group and between group hemodynamic parameters were compared in two different patient groups, in which pneumoperitoneum was formed with low flow (10 Lt/min) and high flow (40 Lt/min), no statistically significant difference was found. However, when the cerebral oxygen saturation values were compared with the baseline values, it was found that the differences between the groups were statistically significant. We believe that the cerebral oxygenation is maintained better in the DAK group compared to the YAK group. Keywords: Laparoscopic cholecystectomy, hemodynamics, pneumoperitoneum, near infrared spectroscopy, cerebrovascular circulation