[Unilateral deterioration of regional cerebral oxygen saturation in a patient with bilateral stenosis of the internal carotid artery during laparoscopic operation].
A 73-year-old woman with bilateral internal carotid artery stenosis, 80% in the left and 70% in the right, was scheduled for a laparoscopic operation for sigmoidrectal colon cancer. During the operation, general anesthesia was maintained with propofol and fentanyl, combined with epidural analgesia. Regional cerebral oxygen saturation (rSo2) was continuously monitored throughout the operation. Thirty minutes after the introduction of pneumoperitoneum with head-down position (Trendelenburg position: TP), only left rSo2 decreased from 52% to 17%. As fraction of oxygen (FI(O2)) was increased from 45% to 100%, mechanical ventilation was adjusted to keep end tidal carbon dioxide pressure at 40 mmHg and dopamine was administered to raise arterial blood pressure, left rSo, recovered to 60%. Thereafter, FIo2 was maintained at 60% and the rSo, was kept at 60% to 70% to the end of the operation. Neurological dysfunctions were not observed after the operation. In order to prevent cerebral ischemic damage from the operation with TP, monitoring of rSo, maybe essential during general anesthesia.
Zaitsu
Masayoshi
M
Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara 228-8555.
Okutomi
Toshiyuki
T
Nakahara
Eri
E
Okamoto
Takashi
T
Itoh
Nobuo
N
Okamoto
Hirotsugu
H
D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D000768:Anesthesia, General; D016893:Carotid Stenosis / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D010535:Laparoscopy; D010100:Oxygen / Q000378:metabolism*; D012004:Rectal Neoplasms / Q000601:surgery; D012811:Sigmoid Neoplasms / Q000601:surgery
D010100:Oxygen