The Effect of Trendelenburg Position on CCA Blood Flow

Study Overview
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Brief Summary
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The investigators will evaluate the change of the common carotid artery blood flow according to patient's position and penumoperitoneum.

Detailed Description
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The study will include 20 patients undergoing gynecological surgery. The common carotid artery blood flow will be measured using Doppler US during the following conditions; supine position before induction of anesthesia, supine position immediately after induction of anesthesia, supine position with penumoperitoneum, head-down position with or without pneumoperitoneum.

Official Title
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Influence of Anesthesia, Pneumoperitoneum, and Patient Position on Common Carotid Artery Blood Flow During Laparoscopic Gynecology Operation

Conditions
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Perfusion, Perioperative/Postoperative Complications

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ASA class I,II patients undergoing gynecology surgery under trendelenburg position Age ranges from 20 to 70 Exclusion Criteria: BMI > 32 Pregnancy Patients who did not agree to study Patients with allergies to the drugs used in this study Patients with anatomical variations or lesions in cervical or cranial vascular portion Patients with arrhythmia that may alter patient's cardiac output(e.g. artrial fibrillation)

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of the common carotid artery blood flow velocity | Common carotid artery blood flow velocity is measured using Doppler US | 1) baseline, 2) Immediately after induction of anesthesia, 3) immediately after pneumoperitoneum, 4) immediately after Trendelenburg position with penumoperitoneum, 5) Immediately after desufflation in Trendelenburg position | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of the common carotid artery beat volume | Common carotid artery beat volume was calculated from median common carotid artery beat velocity and vessel diameter | 1) baseline, 2) Immediately after induction of anesthesia, 3) immediately after pneumoperitoneum, 4) immediately after Trendelenburg position with penumoperitoneum, 5) Immediately after desufflation in Trendelenburg position | 
| Change of the common carotid artery diameter | Common carotid artery diameter is obtained using US | 1) baseline, 2) Immediately after induction of anesthesia, 3) immediately after pneumoperitoneum, 4) immediately after Trendelenburg position with penumoperitoneum, 5) Immediately after desufflation in Trendelenburg position | 
| Change of mean arterial blood pressure | Mean arterial pressure is obtained concurrently with common carotid artery blood flow velocity measurements | 1) baseline, 2) Immediately after induction of anesthesia, 3) immediately after pneumoperitoneum, 4) immediately after Trendelenburg position with penumoperitoneum, 5) Immediately after desufflation in Trendelenburg position | 
| Change of cardiac output | Cardiac output was obtained using FloTrac(EdwardLifescience, USA) | 1) baseline, 2) Immediately after induction of anesthesia, 3) immediately after pneumoperitoneum, 4) immediately after Trendelenburg position with penumoperitoneum, 5) Immediately after desufflation in Trendelenburg position | 
| Change of peak inspiration airway pressure | Peak inspiratory airway pressure is obtained using the ventilator system | 1) baseline, 2) Immediately after induction of anesthesia, 3) immediately after pneumoperitoneum, 4) immediately after Trendelenburg position with penumoperitoneum, 5) Immediately after desufflation in Trendelenburg position | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Common carotid artery, Trendelenburg, Pneumoperitoneum, Blood flow