Influence of the Trendelenburg position and carboxyperitoneum on cerebral tissue oximetry values

Background. Cerebral tissue oximetry (rSO₂) can be used to assess cerebral circulation. Cerebral tissue oximetry studies have been performed in the Trendelenburg position (30º), but data for 45 o are not available.

Objective. To study the effect of the Trendelenburg position (45°) under carboxyperitoneum conditions on rSO₂ and hemodynamic parameters.

Design and methods. A single-center, prospective, descriptive study was conducted among patients (n = 30) who underwent robot-assisted laparoscopic prostatectomy. We measured rSO₂ on the left and right, central venous pressure (CVP), mean arterial pressure (MAP), venous saturation at points: T1 — after induction of anesthesia and start of measurements; T2 — 5 minutes after positioning the patient in the Trendelenburg position of 45^o; T3 — 15 minutes; T4 — 30 minutes; T5 — after returning to a horizontal position. Cerebral perfusion was assessed using cerebral perfusion pressure (CPP).

Results. rSO₂ on the right and left at points T2, T3 and T5 significantly exceeded T1. There was a significant increase in BP mean at T2 and T3, as well as a significant increase in CVP at T2, T3 and T4 compared to T1. The CPP significantly decreased compared to T1 at points T3, T4 and T5.

Conclusions. The Trendelenburg position with a tilt angle of 45º in combination with carboxyperitoneum is accompanied by an increase in rSO₂, blood pressure and CVP.

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