مرکز منطقه ای اطلاع رساني علوم و فناوري - The Importance of Using a Cerebral Oximeter During Gynecologic Laparoscopic Surgery

Abstract :

Objective: To compare the effects of total intravenous anesthesia (TIVA) and inhalation anesthesia on cerebral oxygenation (rSO2) during Trendelenburg, CO2 insufflation and pneumoperitoneum in this study. Methods: Sixty-six ASA I or II women scheduled to undergo diagnostic and/or surgical gynecologic laparoscopy under general anesthesia were randomly allocated to two groups as Group TIVA (n=33) or Group S (n=33) and administered either TIVA or sevoflurane inhalation. Heart rate (HR), mean arterial pressure (MAP), SpO2, rSO2, BIS, ETCO2 were monitored. All parameters were recorded at the onset and end of insufflation, 5 and 10 minutes (min) of Trendelenburg position, 10, 20 and 30 min of pneumoperitoneum and at the end of the operation in the supine position. Results: The rSO2 values recorded after anesthesia induction until the end of the operation in Group TIVA and rSO2 recorded after anesthesia induction, 5 and 10 min of Trendelenburg, and 10 min of pneumoperitoneum were found to be higher than in the control. PaCO2 at 30 min of pneumoperitoneum were significantly higher than that at the onset of insufflation in both groups. The MAP values in the inhalation group during 20 min of pneumoperitoneum at the end of the operation in the supine position were significantly lower than that of the Group TIVA. The MAP values after anesthesia induction, at the onset of insufflation and at the end of the operation in Group TIVA, whereas all of the MAP values in the inhalation group were significantly lower than the control. Conclusion: Even though use of propofol induction in both groups caused a significant increase in cerebral oxygenation with respect to controls without any difference between the groups, when each group was evaluated individually increased rSO2 in the group S mainly originated from the Trendelenburg position, but in the TIVA group additionally continuous propofol infusion could be responsible for the increased rSO2 between anesthesia induction and Trendelenburg position.