Evaluation of Cerebral Venous Return With Internal Jugular Vein Blood Flow in Gynecological Laparoscopic Surgery

NCT ID: NCT04922060

Last Updated: 2021-06-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Total Enrollment

20 participants

Study Classification

OBSERVATIONAL

Study Start Date

2021-06-08

Study Completion Date

2021-06-30

Brief Summary

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The steep Trendelenburg position (STP) provides an advantage in laparoscopic procedures as it optimizes the surgical image. In laparoscopic operations, the need for CO2 pneumoperitoneum (PP), together with this non-physiological position, raises concerns about the patient's physiological homeostasis. Although most patients seem to tolerate the combination of STP and PP, this method carries risks of ICP (intracranial pressure) and brain perfusion. The head-down position increases arterial pressure as well as CVP, thereby disrupting cerebral venous drainage and increasing hydrostatic pressures in the cerebral vascular system. This increases cerebrovascular resistance and decreases cerebral blood flow by increasing ICP and cerebral edema. Systemic CO2 absorption from pneumoperitoneum causes hypercarbia. Hypercarbia can increase cerebral blood flow through cerebral vasodilation.

Seventy-four percent to 95% of cerebral venous drainage in the supine position is provided by IJVs. Studies have shown that IJVs, which are responsible for most cerebral venous drainage, exhibit changes in diameter and blood flow due to TP. These studies were generally conducted on moderate TP and on healthy volunteers. In this study, we aim to evaluate the effects of a steep Trendelenburg position (25°) and pneumoperitoneum on IJV blood flow in patients undergoing operation under general anesthesia

Detailed Description

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Conditions

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Internal Jugular Vein (IJV) Blood Flow in Gynecological Laparoscopic Surgery

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Eligibility Criteria

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Inclusion Criteria

ASA I-II physical status age between 18 and 65 years planned gynecological laparoscopic surgery. -

Exclusion Criteria

history of head and neck surgery history of cerebrovascular disease ASA III-IV physical status

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Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

No

Sponsors

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Selcuk University

OTHER

Sponsor Role lead

Responsible Party

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EMİNE ASLANLAR

Assistant professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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emine ASLANLAR

Role: PRINCIPAL_INVESTIGATOR

selcuk univercity medical faculty

Central Contacts

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emine ASLANLAR

Role: CONTACT

05556219830

Mehmet SARGIN

Role: CONTACT

05322662766

References

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Kalmar AF, Foubert L, Hendrickx JF, Mottrie A, Absalom A, Mortier EP, Struys MM. Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010 Apr;104(4):433-9. doi: 10.1093/bja/aeq018. Epub 2010 Feb 18.

Reference Type RESULT
PMID: 20167583 (View on PubMed)

Yeoh TY, Venkatraghavan L, Fisher JA, Meineri M. Internal jugular vein blood flow in the upright position during external compression and increased central venous pressure: an ultrasound study in healthy volunteers. Can J Anaesth. 2017 Aug;64(8):854-859. doi: 10.1007/s12630-017-0903-3. Epub 2017 Jun 2.

Reference Type RESULT
PMID: 28577164 (View on PubMed)

Uluer MS, Sargin M, Basaran B. Comparison of the effect of the right lateral tilt position and Trendelenburg position on the right internal jugular vein in healthy volunteers: A prospective observational study. J Vasc Access. 2019 Nov;20(6):672-676. doi: 10.1177/1129729819838169. Epub 2019 Apr 12.

Reference Type RESULT
PMID: 30977416 (View on PubMed)

Lee JG, Park HB, Shin HY, Kim JD, Yu SB, Kim DS, Ryu SJ, Kim GH. Effect of Trendelenburg position on right and left internal jugular vein cross-sectional area. Korean J Anesthesiol. 2014 Nov;67(5):305-9. doi: 10.4097/kjae.2014.67.5.305. Epub 2014 Nov 26.

Reference Type RESULT
PMID: 25473458 (View on PubMed)

Terai C, Anada H, Matsushima S, Shimizu S, Okada Y. Effects of mild Trendelenburg on central hemodynamics and internal jugular vein velocity, cross-sectional area, and flow. Am J Emerg Med. 1995 May;13(3):255-8. doi: 10.1016/0735-6757(95)90194-9.

Reference Type RESULT
PMID: 7755812 (View on PubMed)

Marcus HE, Bonkat E, Dagtekin O, Schier R, Petzke F, Wippermann J, Bottiger BW, Teschendorf P. The impact of Trendelenburg position and positive end-expiratory pressure on the internal jugular cross-sectional area. Anesth Analg. 2010 Aug;111(2):432-6. doi: 10.1213/ANE.0b013e3181e2fe41. Epub 2010 May 19.

Reference Type RESULT
PMID: 20484538 (View on PubMed)

Ishida S, Miyati T, Ohno N, Hiratsuka S, Alperin N, Mase M, Gabata T. MRI-based assessment of acute effect of head-down tilt position on intracranial hemodynamics and hydrodynamics. J Magn Reson Imaging. 2018 Feb;47(2):565-571. doi: 10.1002/jmri.25781. Epub 2017 Jun 3.

Reference Type RESULT
PMID: 28577333 (View on PubMed)

Other Identifiers

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EASLANLAR

Identifier Type: -

Identifier Source: org_study_id

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