title: Cerebral oxygenation during laparoscopic surgery: jugular bulb versus regional cerebral oxygen saturation.
abstract: OBJECTIVE
  We hypothesized that regional cerebral oxygen saturation (rSO2) could replace jugular bulb oxygen saturation (SjvO2) in the steep Trendelenburg position under pneumoperitoneum. Therefore, we evaluated the relationship between SjvO2 and rSO2 during laparoscopic surgery.
  
  
  METHODS
  After induction of anesthesia, mechanical ventilation was controlled to increase PaCO2 from 35 to 45 mm Hg in the supine position, and the changes in SjvO2 and rSO2 were measured. Then, after establishment of pneumoperitoneum and Trendelenburg position, ventilation was controlled to maintain a PaCO2 at 35 mm Hg and the CO2 step and measurements were repeated. The changes in SjvO2 (rSO2) -CO2 reactivity were compared in the supine position and Trendelenburg-pneumoperitoneum condition, respectively.
  
  
  RESULTS
  There was little correlation between SjvO2 and rSO2 in the supine position (concordance correlation coefficient=0.2819). Bland-Altman plots showed a mean bias of 8.4% with a limit of agreement of 21.6% and -4.7%. SjvO2 and rSO2 were not correlated during Trendelenburg-pneumoperitoneum condition (concordance correlation coefficient=0.3657). Bland-Altman plots showed a mean bias of 10.6% with a limit of agreement of 23.6% and -2.4%. The SjvO2-CO2 reactivity was higher than rSO2-CO2 reactivity in the supine position and Trendelenburg- pneumoperitoneum condition, respectively (0.9 ± 1.1 vs. 0.4 ± 1.2% mm Hg(-1), p=0.04; 1.7 ± 1.3 vs. 0.5 ± 1.1% mm Hg(-1), p<0.001).
  
  
  CONCLUSIONS
  There is little correlation between SjvO2 and rSO2 in the supine position and Trendelenburg-pneumoperitoneum condition during laparoscopic surgery.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea.
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Soo Hwan
authors.initials: SH
authors.lastname: Kim
authors.forename: Sung Jin
authors.initials: SJ
authors.lastname: Lee
authors.forename: Sa Rah
authors.initials: SR
authors.lastname: Soh
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D001921:Brain / Q000378:metabolism*; D002245:Carbon Dioxide / Q000737:chemistry; D002560:Cerebrovascular Circulation; D018475:Head-Down Tilt; D006801:Humans; D007601:Jugular Veins / Q000378:metabolism*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011028:Pneumoperitoneum, Artificial; D011312:Pressure; D012119:Respiration
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen