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GAS EXCHANGE AND NEUROCOGNITIVE PARAMETERS IN LAPAROSCOPIC CHOLECYSTECTOMY


DOI: http://dx.doi.org/10.18821/0201-7563-2017-62-2-139-144

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Abstract

Aim of the study. To explore the relationship of gas exchange with cognitive function and depth of anesthesia in laparoscopic cholecystectomy. Methods. Totally 170 patients scheduled for laparoscopic cholecystectomy were enrolled into a prospective study and randomized into four groups: 1) normoxia-normocapnia (nO2-nCO2), 2) hyperoxia-normocapnia (hO2-nCO2), 3) normoxia-hypocapnia (nO2-lCO2), 4) hyperoxia-hypocapnia (hO2-lCO2). Normoxia was defined as paO2 within 70-150 mm Hg, hyperoxia - within 150-300 mm Hg. Normocapnia was referred to paCO2 of 35-48 mm Hg, and hypocapnia - to 25-35 mm Hg. All patients were tested for cognitive function using Montreal Cognitive Assessment Score (MoCA), monitoring the depth of anaesthesia was assessed by PSI (Patient State Index). Results. We observed the decrease in MoCA at 6 hours after surgery in the hO2-nCO2 and the hO2-lCO2 groups (p < 0,03). Compared with the nO2-nCO2 group, arterial lactate and pH increased significantly at the end of surgery in the hO2-lCO2 and the nO2-lCO2 groups (p < 0,001). The PSI before induction of anesthesia correlated with age (rho = -0,41, p = 0,01) and baseline MoCA value (rho = 0.80, p < 0,001). In addition, we observed a positive correlation between paCO2 and PSI at the end of intervention (rho = 0,32, p = 0,046). Conclusion. The short-term combination of hyperoxia and hypocapnia during laparoscopic cholecystectomy leads to transient postoperative decline in cognitive function. The PSI correlates with age, baseline cognitive function and paCO2 at the end of the operation


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For citation: Sokolova M.M., Rodionova L.N., Izotova N.N., Telova O.N., Kuz’kov V.V., Kirov M.Yu. Gas exchange and neurocognitive parameters in laparoscopic cholecystectomy. Anesteziologiya i Reanimatologiya (Russian Journal of Anaesthesiology and Reanimatology). 2017; 62(2): 139-144. (In Russ.). DOI: http://dx.doi.org/10.18821/0201-7563-2017-62-2-139-144

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