Association between trendelenburg position and cerebral hypoxia in patients who underwent robotic assisted laparoscopic hysterectomy and prostatectomy

Aim Nowadays the laparoscopic surgeries performed robotic assisted and in trendelenburg position. Depending on the position, increasing of intracranial pressure, cerebral hypoxia, decreasing brain blood flow, hypoxemia and increasing of brain oxygen payment may be occured. Aim of the study is, connection between trendelenburg position and cerebral hypoxia of 50 patients who underwent robotic assisted laparoscopic hysterectomy and prostatectomy. Material Method Material and Methods: After ethics committee aproval and written concent from 50 patient, the prospective study started. The standardized minimental test (SMMT) performed all patients, preoperative 1 hour and postoperative 1 hour. NIRS (Near infared spectroscopy) probe sticked all patients' both side of frontal lobe and standardized general anesthesia protocol performed. NIRS values, hemodynamic and respiratuary parameters:; after anesthesia induction, every 20 minutes in trendelenburg position and after operation at supin position was recorded. Cerebral desaturation and position relationship was investigated. Results %90 of patient was male and mean age was 62.9±6.8. Beginning mean right rSO2 70,5±7,3, left rSO2 70,6±6,7. Right rSO2 values in 20 minutes of trendelenburg position (69,4±8,8; p: 0,042) and 60 minutes (69,2±9,8; p:0,043) significant decreased, also in T120 (74,3±12; p:0,041) increased was detected. Left rSO2 values have no significant changed while compared with the main values at all times (p>0.05). Postoperative SMMT values (24.1 ±3.8) was significant decreased compared with the preoperative period (25.3 ±3.8) (p<0.001). Compared with the beginning and postoperative supin position there was significant positive correlation (p<0.05) between right rSO2 and ETCO2.There was another significant positive correlation (p<0.05) between T60 and postoperative supin period left rSO2 and ETCO2. There was no significant relation between NIRS and cognitive disfunction. Postoperative SMMT values was significant decreased compared preoperative period (p<0.05). Conclusions Patients who underwent robotic assisted laparoscopic operation, trendelenburg position and pneumoperitoneum has negative effects on cerebral perfusion. Especially elder patients are predisposition for cerebral hypoxia and with cerebral monitoring prevented for cerebral complications on time. Key Words: Laparoscopy, NIRS, Robotic surgery, cerebral hipoxia