title: Effects of high positive end-expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitoneum in the Trendelenburg position.
abstract: We investigated the effects of 10 cmH2O positive end-expiratory pressure on cerebral haemodynamics and cerebral oxygenation in patients undergoing laparoscopic lower abdominal surgery in the 30° Trendelenburg position during desflurane anaesthesia. Twenty-six patients were enrolled in this study. After anaesthesia induction, pneumoperitoneum was applied in Trendelenburg position. Twenty minutes later, positive end-expiratory pressure was applied. There was no change in regional cerebral oxygen saturation (p = 0.376). Cerebral perfusion pressure decreased significantly over time (p < 0.001) and positive end-expiratory pressure caused a further decrease in cerebral perfusion pressure (p = 0.036). The application of 10 cmH2O positive end-expiratory pressure during pneumoperitoneum in the Trendelenburg position preserved regional cerebral oxygen saturation, but cerebral perfusion pressure decreased significantly due to its secondary haemodynamic effects.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, South Korea.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Jo
authors.forename: J Y
authors.initials: JY
authors.lastname: Lee
authors.forename: M G
authors.initials: MG
authors.lastname: Lee
authors.forename: H J
authors.initials: HJ
authors.lastname: Kwak
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation; D002560:Cerebrovascular Circulation / Q000502:physiology*; D000077335:Desflurane; D005260:Female; D018475:Head-Down Tilt / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011175:Positive-Pressure Respiration / Q000379:methods*
chemical_list: D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane