Cerebral and hemodynamic responses in elderly patients during laparoscopic cholecystectomy: A cross-sectional study

Abstract

Laparoscopic cholecystectomy is among the most frequently performed abdominal surgeries in the elderly population. However, the physiological changes in hemodynamic and cerebral parameters induced by pneumoperitoneum and the head-up (reverse Trendelenburg) position present notable clinical challenges in this age group. This cross-sectional study aimed to evaluate alterations in cerebral oxygenation and hemodynamic status in elderly patients undergoing laparoscopic cholecystectomy. The study was conducted on 50 elderly patients scheduled for laparoscopic cholecystectomy at Razi Hospital, Rasht, between March 20, 2023, and March 19, 2024. Hemodynamic parameters and cerebral oxygen saturation were recorded at baseline (prior to anesthesia induction), 5 and 15 minutes after abdominal gas insufflation, immediately following gas desufflation, and 15 minutes post-desufflation. The mean patient age was 66.9 ± 7.1 years, with 58% being female. Systolic, diastolic, and mean arterial pressures significantly increased following gas insufflation (P < 0.001), whereas heart rate changes were not statistically significant (P = 0.443). End-tidal carbon dioxide (EtCO₂) levels significantly rose during pneumoperitoneum. Cerebral oxygen saturation initially increased after anesthesia induction, declined post-insufflation, and subsequently recovered in the later stages. Peripheral oxygen saturation (SpO₂) remained stable throughout the procedure. The most commonly observed side effects included hypertension (16%), nausea and vomiting (16%), and bradycardia (8%). The findings indicate that anesthesia induction, pneumoperitoneum, and the reverse Trendelenburg position influence both cardiac function and cerebral perfusion in elderly patients. Specifically, carbon dioxide insufflation into the abdominal cavity is associated with elevated hemodynamic parameters, increased EtCO₂, and transient reductions in cerebral oxygenation across both hemispheres.