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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.
AuthorsY Y Jo, J Y Lee, M G Lee, H J Kwak
JournalAnaesthesia (Anaesthesia) Vol. 68 Issue 9 Pg. 938-43 (Sep 2013) ISSN: 1365-2044 [Electronic] England
PMID23841822 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Copyright© 2013 The Association of Anaesthetists of Great Britain and Ireland.
Chemical References
  • Anesthetics, Inhalation
  • Desflurane
  • Isoflurane
Topics
  • Abdomen (surgery)
  • Adult
  • Aged
  • Anesthetics, Inhalation
  • Cerebrovascular Circulation (physiology)
  • Desflurane
  • Female
  • Head-Down Tilt (physiology)
  • Hemodynamics (physiology)
  • Humans
  • Isoflurane (analogs & derivatives)
  • Laparoscopy (methods)
  • Male
  • Middle Aged
  • Pneumoperitoneum, Artificial (methods)
  • Positive-Pressure Respiration (methods)

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