Cerebral haemodynamic physiology during steep Trendelenburg position and CO2 pneumoperitoneum

A. F. Kalmar*, F. Dewaele, L. Foubert, J. F. Hendrickx, E. H. Heeremans, M. M. R. F. Struys, A. Absalom

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

33 Citations (Scopus)

Abstract

The steep (40) Trendelenburg position optimizes surgical exposure during robotic prostatectomy. The goal of the current study was to elucidate the influence of this patient positioning on cerebral blood flow and zero flow pressure (ZFP), and to assess the validity of different methods of evaluating ZFP.

In 21 consecutive patients who underwent robotic endoscopic radical prostatectomy under general anaesthesia, transcranial Doppler flow velocity waveforms and invasive arterial and central venous pressure (CVP) waveforms suitable for analysis were recorded throughout the whole operative procedure in 14. The ZFP was determined by regression analysis of the pressure-flow plot and by different simplified formulas. The effective cerebral perfusion pressure (eCPP), pulsatility index (PI), and resistance index (RI) were determined.

While patients were in the Trendelenburg position, the ZFP increased in parallel with the CVP. The PI, RI, gradient between the ZFP and CVP, and the gradient between the CPP and the eCPP did not increase significantly (P0.05) after 3 h of the steep Trendelenburg position. Using the formula described by Czosnyka and colleagues, the ZFP correlated closely with that calculated by linear regression throughout the course of the operation.

Prolonged steep Trendelenburg positioning and CO2 pneumoperitoneum does not compromise cerebral perfusion. ZFP and eCPP are reliable variables for assessing brain perfusion during prolonged steep Trendelenburg positioning.

Original languageEnglish
Pages (from-to)478-484
Number of pages7
JournalBritish Journal of Anaesthesia
Volume108
Issue number3
DOIs
Publication statusPublished - Mar-2012

Keywords

  • arteries
  • cerebral
  • brain
  • intracranial pressure
  • measurement techniques
  • flow velocity waveform analysis
  • cerebral blood flow
  • surgery
  • urological
  • TRANSCRANIAL DOPPLER ULTRASONOGRAPHY
  • CRITICAL CLOSING PRESSURE
  • PERFUSION-PRESSURE
  • INTRACRANIAL-PRESSURE
  • RADICAL CYSTECTOMY
  • PROSTATECTOMY
  • CIRCULATION
  • REACTIVITY
  • EXPERIENCE
  • ANESTHESIA

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