Changes in cerebral oximetry during peritoneal insufflation for laparoscopic procedures

Changes in cardiac output may occur during insufflation for laparoscopic procedures. However, there are limited data regarding its potential effects on cerebral oxygenation.

Cerebral oxygenation (ScO(2)), end tidal CO(2), heart rate, blood pressure and oxygen saturation by pulse oximetry were recorded every 5 minutes prior to insufflation, during insufflation and after desufflation. Minute ventilation was increased to maintain normocapnia and the depth of anesthesia was adjusted or fluids/phenylephrine administered to maintain the blood pressure within 20% of the baseline.

The cohort for the study included 70 adults for laparoscopic herniorrhaphy, gastric bypass or cholecystectomy. A total of 1004 ScO(2) values were obtained during laparoscopy. The ScO(2) decreased from the baseline in 758 of the 1004 data points. The ScO(2) was 0-9 less than the baseline in 47.8% of the values, 10-19 less than the baseline in 24.9% of the values and 20-29 less than the baseline in 26 values (2.6%). Eighty-two (8.2%) of the values were less than 80% of the baseline value, while 25 values (2.5%) were less than 75% of the baseline value. Twelve patients had at least one ScO(2) value that was less than 80% of the baseline and 6 had at least one ScO(2) value that was less than 75% of the baseline. Four patients of the cohort had ScO(2) values less than 80% of the baseline for more than 50% of the laparoscopic procedure.

Although relatively uncommon, significant changes in cerebral oxygenation do occur in some patients during insufflation for laparoscopic surgery.