Comparison of the effects of low-flow and normal-flow anesthesia on intracranial pressure, cerebral oxygenation and bispectral index in laparoscopic cholecystectomy operation

A. Mermer, B. Kozanhan

Department of Anesthesiology and Reanimation, Konya City Hospital, Konya, Turkey. draydinmer@gmail.com

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• Anesthesiology

OBJECTIVE: Pneumoperitoneum in laparoscopic surgeries can raise intracranial pressure (ICP). Low-flow anesthesia offers benefits such as improved clearance, temperature preservation, fluid reduction, cost savings, and lower emissions. However, the impact of low-flow anesthesia on ICP during laparoscopic cholecystectomy remains unclear. This study aimed to compare the effects of low-flow anesthesia (0.75 l/min) to those of normal-flow anesthesia (1.5 l/min) on optic nerve sheath diameter (ONSD) in laparoscopic cholecystectomy patients.

PATIENTS AND METHODS: A total of 80 elective laparoscopic cholecystectomy patients were included in the study. Patients were randomly allocated (1:1) into two study groups: a low-flow anesthesia group and a normal-flow group. ONSD, BIS, left and right rSO2, SAP, DAP, MAP, HR, SpO2, EtCO2, peak inspiratory pressure (P-Peak), Mini-Mental State Exam (MMSE), and duration of surgery were recorded.

RESULTS: The results showed that low-flow anesthesia (0.75 l/min) during laparoscopic cholecystectomy had a preventive effect on the increase in ONSD at 30 minutes (T4) into the operation (p = 0.014). BIS values of left and right rSO2 during the preoperative and intraoperative periods were similar.

CONCLUSIONS: In conclusion, low-flow anesthesia during laparoscopic cholecystectomy may benefit ICP by preventing an increase in ONSD.

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