High positive end-expiratory pressure preserves cerebral oxygen saturation during laparoscopic cholecystectomy under propofol anesthesia

Abstract

Positive end-expiratory pressure (PEEP) can improve respiratory mechanics during pneumoperitoneum, but may influence intracranial and cerebral perfusion pressure. This study investigated the changes in hemodynamic parameters and cerebral oxygen saturation (rSO(2)) associated with 10 cmH(2)O PEEP during pneumoperitoneum while undergoing laparoscopic cholecystectomy under propofol anesthesia. Sixty patients aged 18-60 years undergoing laparoscopic cholecystectomy were randomly allocated into two groups: application of no external PEEP (ZEEP group, n = 30) or PEEP = 10 cmH(2)O (PEEP group, n = 30). PEEP was applied after insufflation of CO2. Except for the PEEP level, all other ventilator settings were identical for both groups. Hemodynamic variables, end-tidal carbon dioxide concentration (ETCO2), ventilatory parameters, and rSO(2) were measured. There was no significant difference in rSO(2), mean arterial pressure (MAP), heart rate (HR), and ETCO2 between the groups throughout the study. When compared with baseline, MAP, HR, and ETCO2 increased significantly after insufflation of CO2 in both groups, whereas rSO(2) did not change. No patient had cerebral desaturation, defined as rSO(2) < 80 % of baseline or < 50 % in both groups throughout the study. Application of PEEP with 10 cmH(2)O during CO2 pneumoperitoneum could preserve the rSO(2) value and hemodynamic stability in patients undergoing laparoscopic cholecystectomy under propofol anesthesia.