Evaluation of cerebral venous return with internal jugular vein blood flow in gynecological laparoscopic surgery

Abstract

Aim: The steep Trendelenburg position is frequently used in laparoscopy to improve the surgical image. However, this positioning combined with pneumoperitoneum raises concerns especially in relation to cerebral hemodynamic physiology. In this study, we aimed to evaluate the effects of pneumoperitoneum and steep Trendelenburg position, applied in laparoscopic gynecological surgeries on cerebral venous return, with changes in internal jugular vein (IJV) blood flow. Material and Methods: Twenty patients who underwent laparoscopic gynecological surgery under general anesthesia were included in the study. IJV cross-sectional area (CSA) and Doppler flow velocity were measured with an ultrasonography device at the end of inspiration. IJV blood flow (ml/min) was calculated with the formula of cross-sectional area (cm²) × Doppler flow velocity (cm/sec) × 60. The first measurement was performed in the supine position immediately after endotracheal intubation. The second measurement was performed 1 hour after applying pneumoperitoneum and 25° Trendelenburg position. Results: In the steep Trendelenburg position, there was a significant increase in right and left IJV CSA (p = 0.001; p = 0.038) and blood flow (p = 0.005; p = 0.039), while no significant difference was observed in Doppler flow rate. In the supine position, the right IJV CSA and blood flow were significantly greater than the left IJV CSA and blood flow (p = 0.015 and p = 0.017). Discussion: The steep Trendelenburg position and pneumoperitoneum in laparoscopic gynecological surgeries caused an increase in bilateral IJV blood flow to raise cerebral venous drainage.