The effect of different levels of elevated intraperitoneal pressure on the cerebral perfusion pressure during laparoscopic cholecystectomy

Abstract

Background: In spite of an ever increasing number of laparoscopic techniques, there is still a lot of arguments about multiple aspects of this technique as regards the best method for accessing the peritoneal cavity by creating pneumoperitoneum which may have many effects on cerebral perfusion state and oxygen consumption. We conducted this study to evaluate the effect of different levels of elevated artificial intraperitoneal pressure on the cerebral perfusion pressure (CPP) during laparoscopic cholecystectomy.
Methodology: This prospective, randomized clinical trial enrolled 40 patients scheduled for elective laparoscopic cholecystectomy, 20 - 59 years old, of either sex, and ASA I and II. After ethical approval, patients were randomly assigned into two groups to receive, either: intraperitoneal pressure of 12 mmHg (Group PL) or a pressure of 20 mmHg (Group PH).
Results: No significant differences in heart rate, arterial oxygen saturation and end tidal Co₂ between both groups. Mean arterial pressure and CPP were lower in Group PH vs. Group PL at 2nd intraoperative reading. CPP at this point was lower in both groups compared to basal value, MAP in
Group PH was lower and JBP was higher at 2nd intraoperative reading than basal value. PaO₂ and cerebral oxygen extraction ratio  (COER) were
lower in Group PH vs, Group PL, also PaO₂ was lower in Group PH compared to basal value at 2nd intraoperative reading.
Conclusions: During laparoscopic cholecystectomy, there is frequently reported alterations in cerebral blood flow and intracranial pressure. These changes affect cerebral perfusion pressure and thus may affect cerebral oxygenation.
Citation: Diab DG, Taman HI. The effect of different levels of elevated artificial pneumoperitoneum pressure on the cerebral perfusion pressure during laparoscopic cholecystectomy. Anaesth. pain & intensive care 2019;23(1)___