Özet:

INTRODUCTION: Pneumoperitoneum application during abdominal surgeries can have negative effects on haemodynamic and respiratory parameters. Cerebral oxygenation level is influenced by many factors; the partial arterial CO2 pressure (PaCO2) level is the main determinant factor among them. We investigated the effects of CO2 insufflation and the head-up position on haemodynamic parameters and cerebral oxygenation levels during laparoscopic cholecystectomy with the application of 5 cmH2O positive end–expiratory pressure (PEEP). METHODS: 18-65 years old, forty patients with an ASA physical status of I–II were included in the study. After anaesthesia induction, 5 cmH2O PEEP was applied and CO2 was insufflated into the abdominal space. Patients were operated in the 15° head-up position. RESULTS: Mean cardiac output was observed to be significantly higher after desufflation (5.80 ± 1.39) as compared to the initial values prior to the pneumoperitoneum application (5.08 ± 0.95). (p< 0.05)). There was no significant change in other haemodynamic parameters or cerebral oxygenation levels. PaCO2 and end-tidal CO2 (EtCO2) levels significantly increased during the pneumoperitoneum period (PaCO2 = 33.37 ± 4.97, 36.77 ± 3.91, and 39.35 ± 3.51 mmHg, and EtCO2 = 31.52 ± 2.80, 33.95 ± 3.38, and 35.72 ± 2.92 mmHg; before, at 5 and 20 min after insufflation respectively; p < 0.05). DISCUSSION AND CONCLUSION: Application of 5 cm H2O PEEP does not improve the cerebral oxygenation but may contribute to preservation of baseline values with stable haemodynamic status after insufflation during laparoscopic cholecystectomy. Fluid administering strategy and using opioids are important to achieve stable haemodynamic condition. In addition, mild increased PaCO2 levels may contribute to preserving cerebral oxygenation.

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