Key result
High intra-abdominal pressure links to worse postoperative cognitive function despite unchanged intraoperative cerebral oxygen saturation.
Why the study?
Laparoscopic surgery requires peritoneal gas insufflation, which may increase intra-abdominal pressure (IAP) and alter cerebral blood flow; this study investigated the effect of IAP on cerebral oxygen saturation and postoperative cognitive function recovery.
Does high intra-abdominal pressure affect cerebral oxygen saturation and postoperative cognitive functions in female patients undergoing laparoscopic hysterectomy?
Observational (n=40)
No
Does high intra-abdominal pressure affect cerebral oxygen saturation and postoperative cognitive functions in female patients undergoing laparoscopic hysterectomy?
Absolute Event Rate: 71.46% vs 73.56%
p-value: p=0.435
Maintaining intra-abdominal pressure at ≤12 during laparoscopic hysterectomy may help preserve postoperative cognitive function, despite no observed differences in cerebral oxygen saturation.
High intra-abdominal pressure associated with lower postoperative cognition; leaves open causal effects and need for randomized confirmation.
Objective: Laparoscopic surgery has become more popular than traditional open surgery because it is less invasive, provides faster recovery, and provides better cosmetic success. This procedure requires insufflation of an inert gas into the peritoneal cavity. This may be an increase in arterial CO2, changes in cerebral blood flow, an increase in intra-abdominal pressure (IAP), a decrease in cardiac output. The primary outcome of this study is to show the effect of IAP levels on cerebral oxygen saturation (COS) in patients who underwent laparoscopic total abdominal hysterectomy, and the secondary outcome is to reveal the relationship between IAP and COS and the recovery of postoperative cognitive functions. Material and Method: Demographic data of the cases were recorded and mini-mental test (MMT) was applied to evaluate the preoperative cognitive functions of the cases before surgery. COS monitoring were performed with standard anesthesia procedure for all patients. The MMT was repeated after the surgery. Results: A total of 40 female patients were included in the study. Those with IAP level 12 and below were defined as Group Low-Pressure, and those above 12 were defined as Group High-Pressure. There was no statistical difference between the anesthesia times and recovery times of the two groups. While there was no statistical difference in the preoperative MMT evaluation, it was found to be significantly lower in Group H in the postoperative MMT evaluation. Conclusion: In this study, we evaluated the effect of intraoperative IAP levels on intraoperative COS. It is seen that high IAP level does not have a negative effect on COS. In addition, this study has evidence that high IAP affects postoperative cognitive functions. In intraoperative management for TLH surgery, we recommend maintaining the IAP level at the lowest appropriate pressure that does not impair surgical comfort.
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Yılmaz et al. (2023) conducted an observational in Total laparoscopic abdominal hysterectomy (n=40). High intra-abdominal pressure (>12 mmHg) vs. Low intra-abdominal pressure (≤12 mmHg) was evaluated on Right cerebral oxygen saturation at end of operation (p=0.435). High intra-abdominal pressure (>12 mmHg) during laparoscopic hysterectomy did not negatively affect intraoperative cerebral oxygen saturation but was associated with significantly lower postoperative cognitive function scores.
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