Response of cerebral oxygen metabolism in the head-up position during laparoscopic cholecystectomy

To clarify the influence of the head-up position on cerebral oxygen metabolism during laparoscopy with CO2 insufflation in 12 patients who underwent laparoscopic cholecystectomy, changes in the concentrations of cerebral oxyhemoglobin (HbO2), deoxyhemoglobin (Hb), total hemoglobin (total Hb) and oxidized cytochrome aa3 (Cyt aa3) were measured by use of near-infrared laser spectroscopy. Anesthesia was maintained with nitrous oxide (66%), oxygen, and sevoflurane. Pneumoperitoneum was maintained at an intraabdominal pressure of 10-12 mm Hg by use of CO2. Minute ventilation was adjusted to maintain end-tidal CO2 tension (P(ET)CO2) between 35 and 40 mm Hg during the procedure. Patients were moved from supine to the head-up (20 degree) position before intraabdominal manipulation. The concentration of HbO2 decreased significantly when patients were moved to the head-up position and 30 min thereafter. It remained significantly low after they were returned to the supine position and at the end of surgery. The concentration of Hb was unchanged during the study. Therefore, the concentration of total Hb decreased significantly when patients were moved to the head-up position, as well as 30 min thereafter. It remained significantly low after they were returned to the supine position and at the end of surgery. The concentration of Cyt aa3, however, did not change significantly during the study. These results suggest that the head-up position during laparoscopic cholecystectomy decreases cerebral HbO2 and total Hb.