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已发表论文
妇科腹腔镜手术中术中体位转换对颈内动脉血流的影响
Authors Tan X, Sun W, Zhou H, Zhang L, Dong C
Received 3 June 2025
Accepted for publication 23 August 2025
Published 12 September 2025 Volume 2025:17 Pages 2969—2977
DOI https://doi.org/10.2147/IJWH.S540634
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Vinay Kumar
Xi Tan,1 Wenyi Sun,1 Hao Zhou,1 Li Zhang,2 Chaoxuan Dong1
1Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 5106303, People’s Republic of China; 2Department of Clinical Medicine, The International School of Jinan University, Jinan University, Guangzhou, Guangdong, 510630, People’s Republic of China
Correspondence: Chaoxuan Dong, Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, People’s Republic of China, Tel +86 13354712423, Fax +86 20 38688779, Email dongchaoxuan_dcx@126.com
Objective: Reduced internal carotid artery (ICA) blood flow can cause cerebral hypoperfusion, increasing the risk of intraoperative or postoperative cerebral ischemia. In laparoscopic surgery, postural changes and pneumoperitoneum may further compromise ICA hemodynamics. This study aims to evaluate the effects of intraoperative postural transitions on ICA blood flow in patients undergoing gynecologic laparoscopic surgery.
Methods: A single-center, prospective, non-randomized observational study was performed. Measurements of ICA blood flow, heart rate (HR), and mean arterial pressure (MAP) were obtained at eight intraoperative time points: upon arrival to the operating table while awake (T1), post-induction of anesthesia in the supine position (T2), following pneumoperitoneum in the supine position (T3), immediately after placement in the Trendelenburg position (T4), 10 minutes (T5) and 20 minutes (T6) after Trendelenburg positioning, upon return to the supine position (T7), and at the conclusion of surgery (T8).
Results: A total of 79 patients were enrolled in this study. A significant reduction in ICA blood flow was observed at T2 compared to T1 (263.8 ± 11.4 vs 323.5 ± 12.0 mL/min, p < 0.001), with further reduction at T3 (237.2 ± 9.8 vs 323.5 ± 12.0 mL/min [T1], p < 0.001, vs T1). No statistically significant changes were observed from T4 to T6. Upon transitioning from the Trendelenburg position to supine (T7), ICA blood flow further decreased (202.1 ± 7.5 vs 237.2 ± 9.8 mL/min, p = 0.004), accompanied by reductions in HR (60.0 ± 0.7 vs 66.9 ± 1.0 beats/min, p < 0.001) and MAP (82.8 ± 12.4 vs 93.6 ± 13.5 mmHg, p < 0.001).
Conclusion: Intraoperative postural transitions during gynecologic laparoscopic surgery are associated with fluctuations in ICA blood flow. The return from the Trendelenburg to the supine position results in a marked decrease in ICA blood flow, HR, and MAP.
Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=178094, Identifier: ChiCTR2200065104, Registered October 27, 2022.
Plain Language Summary: This prospective observational study was conducted to enhance the understanding of intraoperative hemodynamic changes associated with postural transitions in gynecologic laparoscopic surgery. Utilizing Doppler ultrasound, fluctuations in internal carotid artery blood flow induced by positional changes were characterized, providing clinically relevant insights for perioperative management and patient safety.
Keywords: gynecologic laparoscopic surgery, internal carotid artery blood flow, intraoperative posture changes, Trendelenburg position
1Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, 5106303, People’s Republic of China; 2Department of Clinical Medicine, The International School of Jinan University, Jinan University, Guangzhou, Guangdong, 510630, People’s Republic of China
Correspondence: Chaoxuan Dong, Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, 510630, People’s Republic of China, Tel +86 13354712423, Fax +86 20 38688779, Email dongchaoxuan_dcx@126.com
Objective: Reduced internal carotid artery (ICA) blood flow can cause cerebral hypoperfusion, increasing the risk of intraoperative or postoperative cerebral ischemia. In laparoscopic surgery, postural changes and pneumoperitoneum may further compromise ICA hemodynamics. This study aims to evaluate the effects of intraoperative postural transitions on ICA blood flow in patients undergoing gynecologic laparoscopic surgery.
Methods: A single-center, prospective, non-randomized observational study was performed. Measurements of ICA blood flow, heart rate (HR), and mean arterial pressure (MAP) were obtained at eight intraoperative time points: upon arrival to the operating table while awake (T1), post-induction of anesthesia in the supine position (T2), following pneumoperitoneum in the supine position (T3), immediately after placement in the Trendelenburg position (T4), 10 minutes (T5) and 20 minutes (T6) after Trendelenburg positioning, upon return to the supine position (T7), and at the conclusion of surgery (T8).
Results: A total of 79 patients were enrolled in this study. A significant reduction in ICA blood flow was observed at T2 compared to T1 (263.8 ± 11.4 vs 323.5 ± 12.0 mL/min, p < 0.001), with further reduction at T3 (237.2 ± 9.8 vs 323.5 ± 12.0 mL/min [T1], p < 0.001, vs T1). No statistically significant changes were observed from T4 to T6. Upon transitioning from the Trendelenburg position to supine (T7), ICA blood flow further decreased (202.1 ± 7.5 vs 237.2 ± 9.8 mL/min, p = 0.004), accompanied by reductions in HR (60.0 ± 0.7 vs 66.9 ± 1.0 beats/min, p < 0.001) and MAP (82.8 ± 12.4 vs 93.6 ± 13.5 mmHg, p < 0.001).
Conclusion: Intraoperative postural transitions during gynecologic laparoscopic surgery are associated with fluctuations in ICA blood flow. The return from the Trendelenburg to the supine position results in a marked decrease in ICA blood flow, HR, and MAP.
Clinical Trial Registration: https://www.chictr.org.cn/showproj.html?proj=178094, Identifier: ChiCTR2200065104, Registered October 27, 2022.
Plain Language Summary: This prospective observational study was conducted to enhance the understanding of intraoperative hemodynamic changes associated with postural transitions in gynecologic laparoscopic surgery. Utilizing Doppler ultrasound, fluctuations in internal carotid artery blood flow induced by positional changes were characterized, providing clinically relevant insights for perioperative management and patient safety.
Keywords: gynecologic laparoscopic surgery, internal carotid artery blood flow, intraoperative posture changes, Trendelenburg position