Changes in cerebral oxygen saturation and early postoperative cognitive function after laparoscopic gastrectomy: a comparison with conventional open surgery

Youn Yi Jo, Jong Yeop Kim, Mi Geum Lee, Seul Gi Lee, Hyun Jeong Kwak, Youn Yi Jo, Jong Yeop Kim, Mi Geum Lee, Seul Gi Lee, Hyun Jeong Kwak

Abstract

Background: Laparoscopic gastrectomy requires a reverse-Trendelenburg position and prolonged pneumoperitoneum and it could cause significant changes in cerebral homeostasis and lead to cognitive dysfunction. We compared changes in regional cerebral oxygen saturation (rSO2), early postoperative cognitive function and hemodynamic variables in patients undergoing laparoscopic gastrectomy with those patients that underwent conventional open gastrectomy.

Methods: Sixty patients were enrolled in this study and the patients were distributed to receive either laparoscopic gastrectomy (laparoscopy group, n = 30) or open conventional gastrectomy (open group, n = 30). rSO2, end-tidal carbon dioxide tension, hemodynamic variables and arterial blood gas analysis were monitored during the operation. The enrolled patients underwent the mini-mental state examination 1 day before and 5 days after surgery for evaluation of early postoperative cognitive function.

Results: Compared to baseline value, rSO2 and end-tidal carbon dioxide tension increased significantly in the laparoscopy group after pneumoperitoneum, whereas no change was observed in the open group. No patient experienced cerebral oxygen desaturation or postoperative cognitive dysfunction. Changes in mean arterial pressure over time were significantly different between the groups (P < 0.001).

Conclusions: Both laparoscopic and open gastrectomy did not induce cerebral desaturation or early postoperative cognitive dysfunction in patients under desflurane anesthesia. However, rSO2 values during surgery favoured laparoscopic surgery, which was possibly related to increased cerebral blood flow due to increased carbon dioxide tension and the effect of a reverse Trendelenburg position.

Keywords: Cerebral oxygen saturation; Laparoscopic gastrectomy; Postoperative cognitive function.

Figures

Fig. 1. Changes in mean arterial pressure,…
Fig. 1. Changes in mean arterial pressure, heart rate, end-tidal carbon dioxide tension, and regional cerebral oxygen saturation in the laparoscopy (○) and open (●) groups. Error bars are SDs. IND: 10 min after anesthesia induction, T0: immediately after CO2 insufflation in the laparoscopy group or peritoneal opening in the open group, T10–50: 10–50 min after CO2 insufflation in the laparoscopy group or peritoneal opening in the open group, END: end of operation, MAP: Mean arterial blood pressure, HR: heart rate. *P < 0.05 vs. open group, †P < 0.05 vs. IND within the group.

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Source: PubMed

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