• Hyun Jeong Kwak, Sun Kyung Park, Kyung Cheon Lee, Dong Chul Lee, and Jong Yeop Kim.
• Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon, Korea.
• Surg Endosc. 2013 Feb 1;27(2):415-20.

BackgroundPositive end-expiratory pressure (PEEP) can improve respiratory mechanics during pneumoperitoneum, but may influence intracranial and cerebral perfusion pressure. This study investigated the changes in hemodynamic parameters and cerebral oxygen saturation (rSO(2)) associated with 10 cmH(2)O PEEP during pneumoperitoneum while undergoing laparoscopic cholecystectomy under propofol anesthesia.MethodsSixty patients aged 18-60 years undergoing laparoscopic cholecystectomy were randomly allocated into two groups: application of no external PEEP (ZEEP group, n = 30) or PEEP = 10 cmH(2)O (PEEP group, n = 30). PEEP was applied after insufflation of CO(2). Except for the PEEP level, all other ventilator settings were identical for both groups. Hemodynamic variables, end-tidal carbon dioxide concentration (ETCO(2)), ventilatory parameters, and rSO(2) were measured.ResultsThere was no significant difference in rSO(2), mean arterial pressure (MAP), heart rate (HR), and ETCO(2) between the groups throughout the study. When compared with baseline, MAP, HR, and ETCO(2) increased significantly after insufflation of CO(2) in both groups, whereas rSO(2) did not change. No patient had cerebral desaturation, defined as rSO(2) <80 % of baseline or <50 % in both groups throughout the study.ConclusionApplication of PEEP with 10 cmH(2)O during CO(2) pneumoperitoneum could preserve the rSO(2) value and hemodynamic stability in patients undergoing laparoscopic cholecystectomy under propofol anesthesia.

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