Background Laparoscopic surgery involves the use of general anesthesia, pneumoperitoneum with carbon dioxide, and specific positioning, which affect brain metabolic demands, vascular autoregulation, intra‐abdominal pressure elevation, and hypercapnia, as well as alterations in cerebral blood flow and intracranial pressure (ICP). Currently, few studies have employed noninvasive ultrasound to monitor dynamic changes in cerebral blood supply and pressure during surgery. Dynamic monitoring of cerebral blood flow and ICP is clinically relevant for optimizing anesthetic management and perioperative brain protection during laparoscopic surgery. Methods We conducted a prospective study on 76 patients who underwent laparoscopic surgery. In the TREND group (Trendelenburg position), 14 patients (50%) underwent laparoscopic hysterectomy and 16 patients (50%) underwent laparoscopic oophorectomy. In the REV group (Reverse Trendelenburg position), 30 patients (50%) underwent laparoscopic cholecystectomy. Measurements were taken at five time points: before anesthesia (T 1 ), after intubation (T 2 ), after positional change (Trendelenburg or Reverse Trendelenburg) (T 3 ), after pneumoperitoneum (T 4 ), and at the end of surgery (T 5 ). Recorded parameters included mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), peak inspiratory pressure (PIP), end‐tidal carbon dioxide concentration (ETCO 2 ), total volume (TV), common carotid artery (CCA) flow, CCA beat volume, CCA diameter, and optic nerve sheath diameter (ONSD). Results After pneumoperitoneum, both the TREND and REV groups showed a significant increase in MAP and HR. Repeated‐measures analysis demonstrated significant within‐group differences in hemodynamic parameters at T3, T4, and T5 compared with those in T2 in both groups ( p < 0.05). In addition, between‐group comparisons revealed significant differences in the CCA flow and ONSD at selected intraoperative time points. In the REV group, CCA flow decreased after the Reverse Trendelenburg position ( p = 0.0213). Comparison of CCA flow at T 3 between the TREND and REV groups showed a significant difference ( p = 0.0075). After pneumoperitoneum, ONSD was significantly smaller in the REV group compared to that in the TREND group ( p = 0.0021). Conclusions Anesthesia reduces CCA flow and CCA beat volume, while the Reverse Trendelenburg position decreases CCA flow but has no effect on CCA beat volume. Pneumoperitoneum increases ONSD width, indicating elevated ICP. We also observed that during anesthesia and the Trendelenburg position, patients’ ONSD significantly increased, indicating a rise in ICP. Trial Registration: ClinicalTrials.gov identifier: NCT06805747
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