Changes in cerebral hemodynamics during laparoscopic cholecystectomy

Laparoscopic surgery requires a series of procedures, including intraperito neal CO2 insufflation, which can cause cardiovascular and hemogasanalytic m odifications, potentially able to impair cerebral perfusion. The aim of thi s study was to evaluate changes in cerebral blood flow velocity during lapa roscopic cholecystectomy. Eighteen patients undergoing laparoscopic cholecy stectomy were studied Middle cerebral artery blood flow velocity was monito red using transcranial Doppler ultrasonography. Electrical bioimpedance was employed to measure cardiac output, stroke volume and to calculate derived parameters. End-tidal CO2, mean arterial blood pressure, end expiratory an esthetic concentration and O-2 saturation were monitored non-invasively. Ce rebral artery blood flow velocity increased significantly after CO2 insuffl ation (p < 0.05) and remained stable. The highest values were reached after CO2 desufflation. A significant reduction in stroke volume and cardiac out put (p < 0.05) associated with increased vascular systemic resistances (p < 0.001) was observed soon after CO2 insufflation. The decrease in cardiac o utput and the increase in vascular systemic resistances remained significan t throughout abdominal insufflation. Heart rate and mean arterial pressure remained substantially unchanged with the exception of a significant decrea se (p < 0.001) before CO2 insufflation. There was no significant change in end-tidal CO2 during abdominal insufflation. These findings suggest that th e cerebrovascular system can undergo adaptive changes during all phases of laparoscopic surgery, However, the extent of cardio- and cerebrovascular va riation indicates the need for careful preliminary evaluation of cerebral h emodynamics in patients with vascular disorders before laparoscopic surgery .