title: High positive end-expiratory pressure preserves cerebral oxygen saturation during laparoscopic cholecystectomy under propofol anesthesia.
abstract: BACKGROUND
  Positive end-expiratory pressure (PEEP) can improve respiratory mechanics during pneumoperitoneum, but may influence intracranial and cerebral perfusion pressure. This study investigated the changes in hemodynamic parameters and cerebral oxygen saturation (rSO(2)) associated with 10 cmH(2)O PEEP during pneumoperitoneum while undergoing laparoscopic cholecystectomy under propofol anesthesia.
  
  
  METHODS
  Sixty patients aged 18-60 years undergoing laparoscopic cholecystectomy were randomly allocated into two groups: application of no external PEEP (ZEEP group, n = 30) or PEEP = 10 cmH(2)O (PEEP group, n = 30). PEEP was applied after insufflation of CO(2). Except for the PEEP level, all other ventilator settings were identical for both groups. Hemodynamic variables, end-tidal carbon dioxide concentration (ETCO(2)), ventilatory parameters, and rSO(2) were measured.
  
  
  RESULTS
  There was no significant difference in rSO(2), mean arterial pressure (MAP), heart rate (HR), and ETCO(2) between the groups throughout the study. When compared with baseline, MAP, HR, and ETCO(2) increased significantly after insufflation of CO(2) in both groups, whereas rSO(2) did not change. No patient had cerebral desaturation, defined as rSO(2) <80 % of baseline or <50 % in both groups throughout the study.
  
  
  CONCLUSIONS
  Application of PEEP with 10 cmH(2)O during CO(2) pneumoperitoneum could preserve the rSO(2) value and hemodynamic stability in patients undergoing laparoscopic cholecystectomy under propofol anesthesia.
authors: Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea.
authors: Hyun Jeong
authors: HJ
authors: Kwak
authors: Sun Kyung
authors: SK
authors: Park
authors: Kyung Cheon
authors: KC
authors: Lee
authors: Dong Chul
authors: DC
authors: Lee
authors: Jong Yeop
authors: JY
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia; D018686:Anesthetics, Intravenous; D001921:Brain / Q000378:metabolism*; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011028:Pneumoperitoneum, Artificial; D011175:Positive-Pressure Respiration; D015742:Propofol; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D010100:Oxygen; D015742:Propofol