| Visual Observation of the Effect of Modified Chest-Up Trendelenburg Position on Intracranial Pressure and Cerebral Circulation in Elderly Patients During Laparoscopic Gynecologic Surgery |
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| Citation of this paper:SHI Feng,LI Jinbao,DENG Xiaoming,XU Bo.Visual Observation of the Effect of Modified Chest-Up Trendelenburg Position on Intracranial Pressure and Cerebral Circulation in Elderly Patients During Laparoscopic Gynecologic Surgery[J].Chinese Journal of Clinical Medicine,2016,23(1):63-66 |
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| Author Name | Affiliation | E-mail | | SHI Feng | Department of Anesthesia, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
Department of Anesthesia, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200082, China | | | LI Jinbao | Department of Anesthesia, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China | | | DENG Xiaoming | Department of Anesthesia, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China | deng_x@yahoo.com | | XU Bo | Department of Anesthesia, Wuxi People's Hospital, Nanjing Medical University, Wuxi 214023, China | |
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| Abstract:Objective: To observe the change of intracranial pressure(ICP) and cerebral hemodynamics of elderly patients undergoing laparoscopic gynecological surgery in modified chest-up Trendelenburg position(T position) by ultrasound. Methods: Forty ASA I-Ⅱpatients, aged ≥60 yr, weighed 44-69 kg,scheduled for elective gynecological surgery, were randomly divided into 2 groups with 20 in each. Patients of study group(group M) were placed in chest-up T position by using custom made posture cushions. And patients of control group(group T) were placed in conventional T position.The optic nerve sheath diameter(ONSD),time-average peak velocity(TAPV) of middle cerebral artery,pulse index(PI),and resistance index(RI) in supine position at 5 min after regular general anesthesia induction (T1),and that in modified T position or T position immediately after pneumoperitoneum (T2), 30 min later(T3), 60 min later(T4), 90 min later(T5),and that in horizon position at 15 min after deflation(T6), were measured. Results: Compared with that at T1,the TAP and PI at T2,3,4,5 significantly increased in both groups, the ONSD and RI at T4,5 significantly increased in group M, and the ONSD and RI at T3,4,5,6 and PI at T6 significantly increased in group T(P＜0.05).Compared with that in group T, the ONSD and RI at T3 and T6 significantly decreased in group M, and the TAP and PI at T2 significantly decreased in group M (P＜0.05). Conclusions: Modified chest-up T position delays the increase of ICP and cerebral blood flow(CBF),and accelerates their recovery to the normal range after deflation. It is conducive to the safety of prolonged surgery. |
| keywords:Laparoscopy Gynecological surgery Head-down tilt Intracranial pressure Cerebral blood flow 〖FL |
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