Evaluation of the relationship between intraoperative cerebral oxygen saturation and postoperative cognitive functions in laparoscopic hysterectomy surgery

Year 2023, , 121 - 125, 31.01.2023

Resul Yılmaz , Hasan Çekdemir , Emine Türen Demir , Şule Arıcan , Gülçin Hacıbeyoğlu , Ruhiye Reisli , Sema Tuncer

https://doi.org/10.16899/jcm.1217548

Abstract

Objective: Laparoscopic surgery has become more popular than traditional open surgery because it is less invasive, provides faster recovery, and provides better cosmetic success. This procedure requires insufflation of an inert gas into the peritoneal cavity. This may be an increase in arterial CO2, changes in cerebral blood flow, an increase in intra-abdominal pressure (IAP), a decrease in cardiac output. The primary outcome of this study is to show the effect of IAP levels on cerebral oxygen saturation (COS) in patients who underwent laparoscopic total abdominal hysterectomy, and the secondary outcome is to reveal the relationship between IAP and COS and the recovery of postoperative cognitive functions.
Material and Method: Demographic data of the cases were recorded and mini-mental test (MMT) was applied to evaluate the preoperative cognitive functions of the cases before surgery. COS monitoring were performed with standard anesthesia procedure for all patients. The MMT was repeated after the surgery.
Results: A total of 40 female patients were included in the study. Those with IAP level 12 and below were defined as Group Low-Pressure, and those above 12 were defined as Group High-Pressure. There was no statistical difference between the anesthesia times and recovery times of the two groups. While there was no statistical difference in the preoperative MMT evaluation, it was found to be significantly lower in Group H in the postoperative MMT evaluation.
Conclusion: In this study, we evaluated the effect of intraoperative IAP levels on intraoperative COS. It is seen that high IAP level does not have a negative effect on COS. In addition, this study has evidence that high IAP affects postoperative cognitive functions. In intraoperative management for TLH surgery, we recommend maintaining the IAP level at the lowest appropriate pressure that does not impair surgical comfort.

Keywords

cerebral oxygen saturation, cognitive functions, laparoscopic hysterectomy, general anesthesia

Laparaskopik histerektomi cerrahisinde intraoperatif serebral oksijen saturasyonu ile postoperatif kognitif fonksiyonların ilişkisinin değerlendirilmesi

Abstract

Amaç: Laparoskopik cerrahi, daha az invaziv olması, daha hızlı iyileşme sağlaması ve daha iyi kozmetik başarı sağlaması nedeniyle geleneksel açık cerrahiden daha popüler hale gelmiştir. Bu prosedür, inert bir gazın periton boşluğuna üflenmesini gerektirir. Bu, arteriyel karbondioksit basıncında bir artış, serebral kan akışında değişiklikler, karın içi basıncında (İAB) bir artış, kalp debisinde bir azalma olabilir. Bu çalışmanın birincil sonucu, laparoskopik total abdominal histerektomi uygulanan hastalarda İAB düzeylerinin serebral oksijen satürasyonu (SOS) üzerindeki etkisini göstermek ve ikincil sonuç, İAB ve SOS ile postoperatif bilişsel işlevlerin iyileşmesi arasındaki ilişkiyi ortaya koymaktır.
Gereç ve Yöntem: Olguların demografik verileri kaydedildi ve olgulara ameliyat öncesi kognitif fonksiyonlarını değerlendirmek için ameliyat öncesi mini-mental test (MMT) uygulandı. Tüm hastalar için standart anestezi prosedürü ile SOS monitörizasyonu yapıldı. MMT ameliyattan sonra tekrarlandı.
Bulgular: Çalışmaya toplam 40 kadın hasta dahil edildi. IAB seviyesi 12 ve altında olanlar Grup Düşük-Basınç (Grup L), 12'nin üzerinde olanlar Grup Yüksek-Basınç (Grup H) olarak tanımlandı. İki grubun anestezi süreleri ve derlenme süreleri arasında istatistiksel fark yoktu. Preoperatif MMT değerlendirmesinde istatistiksel olarak fark bulunmazken, postoperatif MMT değerlendirmesinde Grup H'de anlamlı olarak düşük bulundu.
Sonuç: Bu çalışmada intraoperatif İAB düzeylerinin intraoperatif SOS'a etkisini değerlendirdik. Yüksek İAB düzeyinin SOS'a olumsuz etkisinin olmadığı görüldü. Ayrıca bu çalışmada yüksek İAB'nin ameliyat sonrası kognitif fonksiyonları etkilediğine dair kanıtlar var. TLH cerrahisi için intraoperatif yönetimde, İAB seviyesinin cerrahi konforu bozmayan uygun en düşük basınçta tutulmasını öneririz.

Keywords

cerebral oxygen saturation, cognitive functions, laparoscopic hysterectomy

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