Cerebrovascular changes during laproscopic vesico-vaginal repair

Document Type : Case report

Authors

1 Division of Neuroanesthesia, Post graduate institute of Medical Education and Research (PGIMER), Chandigarh, India

2 Neuroanesthesia Cell, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

3 Department of Urology, Indira Gandhi Medical College, Shimla

Abstract

Background: Pneumoperitoneum using carbon di-oxide produces cardiac and cerebrovascular changes that can be harmful in patients with coexisting diseases. Therefore we decided to monitor its effect on cerebral vasculature, taking trans-temporal color coded doppler sonography guided identification of Middle cerebral artery (MCA) flow velocity as an index of measurement of cerebral blood flow.



Case Report: After administration of general anesthesia, the MCA flow velocity trend exhibited elevation in both of the patients. The first patient had this elevation, correlating to the corresponding increase in the end tidal carbon di-oxide (EtCO2) levels. The second patient, had this elevation correlating to the decrease in the fraction of inspired oxygen (FiO2) levels. The postulated mechanism for these changes is cerebral hyperemia, which develops after induced pneumoperitoneum. The time of emergence from anesthesia was also recorded for both the cases.



Conclusion: The monitoring of cerebral blood flow velocities during prolonged laparoscopic procedures has not yet been widely studied. Its impact on emergence from anesthesia and post-operative cognitive deficits is an upcoming area of great interest. These effects of pneumoperitoneum on cerebral vasculature only get accentuated in prolonged duration of surgery.

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