Related Experiment Video
Updated: Jan 22, 2026
The Role of Indocyanine Green Fluorescence in Complex Laparoscopic Cholecystectomy Navigation
Published on: January 31, 2025
Internal Carotid Artery Blood Flow Response to Anesthesia, Pneumoperitoneum, and Head-up Tilt during Laparoscopic
Maria Skytioti1, Maja Elstad, Signe Søvik
1From the Division of Physiology, Institute of Basic Medical Sciences (M.S., M.E.) Institute of Clinical Medicine, Faculty of Medicine (S.S.), University of Oslo, Oslo, Norway Department of Anesthesia and Intensive Care, Akershus University Hospital, Lørenskog, Norway (S.S.).
Insights
General anesthesia and pneumoperitoneum significantly decrease cerebral blood flow during laparoscopic surgery. Reductions in cardiac index and mean arterial pressure are key contributors to this effect.
Area of Science:
- Anesthesiology
- Neurosurgery
- Cardiovascular Physiology
Background:
- General anesthesia and pneumoperitoneum are common in laparoscopic surgery.
- Their impact on cerebral blood flow (CBF) in humans is not well understood.
- This study investigates CBF changes during laparoscopic cholecystectomy.
Purpose of the Study:
- To quantify the effect of general anesthesia, pneumoperitoneum, and head-up tilt on internal carotid artery blood flow (ICBF).
- To identify cardiorespiratory factors influencing ICBF during laparoscopic procedures.
Main Methods:
- Observational study of 16 patients undergoing laparoscopic cholecystectomy.
- Internal carotid artery blood velocity and diameter measured by Doppler ultrasound.
- Calculated ICBF, mean arterial blood pressure (MAP), and cardiac index (CI) at four time points.
Main Results:
- ICBF decreased by 37% after anesthesia induction and an additional 15% with pneumoperitoneum.
- MAP and CI significantly decreased with anesthesia and pneumoperitoneum.
- Head-up tilt did not further reduce ICBF.
- Reduced CI and MAP were independently associated with decreased ICBF.
Conclusions:
- General anesthesia and pneumoperitoneum significantly reduce cerebral perfusion during laparoscopic cholecystectomy.
- Decreased cardiac output and mean arterial pressure are primary drivers of reduced ICBF.
- Maintaining adequate cardiac output and MAP is crucial for cerebral perfusion in these patients.
Background:
Little is known about how implementation of pneumoperitoneum and head-up tilt position contributes to general anesthesia-induced decrease in cerebral blood flow in humans. We investigated this question in patients undergoing laparoscopic cholecystectomy, hypothesizing that cardiorespiratory changes during this procedure would reduce cerebral perfusion.
Methods:
In a nonrandomized, observational study of 16 patients (American Society of Anesthesiologists physical status I or II) undergoing laparoscopic cholecystectomy, internal carotid artery blood velocity was measured by Doppler ultrasound at four time points: awake, after anesthesia induction, after induction of pneumoperitoneum, and after head-up tilt. Vessel diameter was obtained each time, and internal carotid artery blood flow, the main outcome variable, was calculated. The authors recorded pulse contour estimated mean arterial blood pressure (MAP), heart rate (HR), stroke volume (SV) index, cardiac index, end-tidal carbon dioxide (ETCO2), bispectral index, and ventilator settings. Results are medians (95% CI).
Results:
Internal carotid artery blood flow decreased upon anesthesia induction from 350 ml/min (273 to 410) to 213 ml/min (175 to 249; -37%, P < 0.001), and tended to decrease further with pneumoperitoneum (178 ml/min [127 to 208], -15%, P = 0.026). Tilt induced no further change (171 ml/min [134 to 205]). ETCO2 and bispectral index were unchanged after induction. MAP decreased with anesthesia, from 102 (91 to 108) to 72 (65 to 76) mmHg, and then remained unchanged (Pneumoperitoneum: 70 [63 to 75]; Tilt: 74 [66 to 78]). Cardiac index decreased with anesthesia and with pneumoperitoneum (overall from 3.2 [2.7 to 3.5] to 2.3 [1.9 to 2.5] l · min · m); tilt induced no further change (2.1 [1.8 to 2.3]). Multiple regression analysis attributed the fall in internal carotid artery blood flow to reduced cardiac index (both HR and SV index contributing) and MAP (P < 0.001). Vessel diameter also declined (P < 0.01).
Conclusions:
During laparoscopic cholecystectomy, internal carotid artery blood flow declined with anesthesia and with pneumoperitoneum, in close association with reductions in cardiac index and MAP. Head-up tilt caused no further reduction. Cardiac output independently affects human cerebral blood flow.
More Related Videos
10:01Modeling Brain Metastasis by Internal Carotid Artery Injection of Cancer Cells
Published on: August 2, 2022
11:00A Model of Disturbed Flow-Induced Atherosclerosis in Mouse Carotid Artery by Partial Ligation and a Simple Method of RNA Isolation from Carotid Endothelium
Published on: June 22, 2010
Related Concept Videos
01:26Arteries of the Head and Neck
The internal carotid arteries supply blood to the anterior portion of the cerebrum. They enter the...
01:29Blood Flow
01:17Autoregulation of Blood Flow
Chemical Signaling in Autoregulation
Chemical signaling operates at the precapillary sphincter level, inciting either contraction or relaxation....
01:31Internal Receptors
02:00Internal Energy
01:24General Anesthesia: Overview
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...