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| Effects of Different End-tidal Carbon Dioxide Partial Pressure during Anaesthesia on Cerebral Blood Perfusion and Cognitive Function in Patients undergoing Laparoscopic Inguinal Hernia Repair |
| WANG Cui-fang |
| Weihai municipal Third Hospital,Weihai, Shandong,264200 |
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Abstract 【Objective】To investigate the effects of different end-tidal carbon dioxide partial pressure (PETCO2) during anaesthesia on cerebral blood perfusion and cognitive function in patients undergoing laparoscopic inguinal hernia repair (LIHR).【Methods】A total of 98 patients with LIHR under general anesthesia were randomly divided into normal PETCO2 group (L group) and mild-high PETCO2 group (H Group), with 49 cases in each group. The PETCO2 was controlled at 35-39 mmHg and 40~45 mmHg in the group L and the group H, respectively. The effects of PETCO2 through regulating tidal volume (VT) and respiratory rate (RR) on cerebral blood perfusion and postoperative cognitive function were analyzed. 【Results】 The VT, RR, Ppeak (peak airway pressure) and PETCO2 of T1(5min), T2(15min), T3(30min), T4(60min) and T5(60min) after pneumoperitoneum in the group L were higher than T0 (5min before pneumoperitoneum) in the group L; Also, they were higher than those at the same time point of the group H (P<0.05). The Da-jvO2 (arterial-venous blood oxygen content difference ) and CERO2 (cerebral oxygen uptake rate ) at T1, T2, T3,T4,T5 in the group L were higher than those at T0 of the group L and at T3, T4 and T5 of the group H (P<0.05). Ppeak, PETCO2 ,Da-jvO2 and CERO2 at T1, T2, T3,T4,T5 and RR at T2, T3, T4, T5 were higher than those at T0 in the group H (P<0.05). The Vm (average flow rate),Vs (peak cerebral systolic flow rate) and Vd (end-diastolic flow rate ) of the group H (45 mmHg for PETCO2) were higher than those before anesthesia and the group L (35 mmHg for PETCO2) (P<0.05). The PI (pulsatility index) and RI (resistance index) of the group H were lower than before the anesthesia; and they were also lower than those of the group L (P<0.05). Compared to 1 day before operation, the number span (inverse), number symbol and MMSE in both groups at 3 days after operation decreased and the trace line increased. In group L, the number span (sequential), vocabulary fluency and word recognition decreased (P<0.05). At 3 days after operation, the word recognition and MMSE of group L were lower than that those of group H (P<0.05).【Conclusion】 In the general anesthesia of laparoscopic inguinal hernia repair, increasing PETCO2 can properly improve cerebral blood perfusion and effectively reduce the incidence of postoperative cognitive impairment.
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Received: 06 November 2018
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2020, Vol. 37 
