High positive end-expiratory pressure preserves cerebral oxygen saturation during laparoscopic cholecystectomy under propofol anesthesia
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- Kwak, H.J., Park, S.K., Lee, K.C. et al. Surg Endosc (2013) 27: 415. doi:10.1007/s00464-012-2447-5
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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 (rSO2) associated with 10 cmH2O PEEP during pneumoperitoneum while undergoing laparoscopic cholecystectomy under propofol anesthesia.
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 cmH2O (PEEP group, n = 30). PEEP was applied after insufflation of CO2. Except for the PEEP level, all other ventilator settings were identical for both groups. Hemodynamic variables, end-tidal carbon dioxide concentration (ETCO2), ventilatory parameters, and rSO2 were measured.
There was no significant difference in rSO2, mean arterial pressure (MAP), heart rate (HR), and ETCO2 between the groups throughout the study. When compared with baseline, MAP, HR, and ETCO2 increased significantly after insufflation of CO2 in both groups, whereas rSO2 did not change. No patient had cerebral desaturation, defined as rSO2 <80 % of baseline or <50 % in both groups throughout the study.
Application of PEEP with 10 cmH2O during CO2 pneumoperitoneum could preserve the rSO2 value and hemodynamic stability in patients undergoing laparoscopic cholecystectomy under propofol anesthesia.