{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T13:10:30Z","timestamp":1792069830852,"version":"4.4.0"},"reference-count":29,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T00:00:00Z","timestamp":1634169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Cerebral hemodynamics may be altered by hypercapnia during a lung-protective ventilation (LPV), CO2 pneumoperitoneum, and Trendelenburg position during general anesthesia. The purpose of this study was to compare the effects of normocapnia and mild hypercapnia on the optic nerve sheath diameter (ONSD), regional cerebral oxygen saturation (rSO2), and intraoperative respiratory mechanics in patients undergoing gynecological laparoscopy under total intravenous anesthesia (TIVA). Sixty patients (aged between 19 and 65 years) scheduled for laparoscopic gynecological surgery in the Trendelenburg position. Patients under propofol\/remifentanil total intravenous anesthesia were randomly assigned to either the normocapnia group (target PaCO2 = 35 mmHg, n = 30) or the hypercapnia group (target PaCO2 = 50 mmHg, n = 30). The ONSD, rSO2, and respiratory and hemodynamic parameters were measured at 5 min after anesthetic induction (Tind) in the supine position, and at 10 min and 40 min after pneumoperitoneum (Tpp10 and Tpp40, respectively) in the Trendelenburg position. There was no significant intergroup difference in change over time in the ONSD (p = 0.318). The ONSD increased significantly at Tpp40 when compared to Tind in both normocapnia and hypercapnia groups (p = 0.02 and 0.002, respectively). There was a significant intergroup difference in changes over time in the rSO2 (p &lt; 0.001). The rSO2 decreased significantly in the normocapnia group (p = 0.01), whereas it increased significantly in the hypercapnia group at Tpp40 compared with Tind (p = 0.002). Alveolar dead space was significantly higher in the normocapnia group than in the hypercapnia group at Tpp40 (p = 0.001). In conclusion, mild hypercapnia during the LPV might not aggravate the increase in the ONSD during CO2 pneumoperitoneum in the Trendelenburg position and could improve rSO2 compared to normocapnia in patients undergoing gynecological laparoscopy with TIVA.<\/jats:p>","DOI":"10.3390\/jcm10204707","type":"journal-article","created":{"date-parts":[[2021,10,14]],"date-time":"2021-10-14T09:10:49Z","timestamp":1634202649000},"page":"4707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparison of the Effects of Normocapnia and Mild Hypercapnia on the Optic Nerve Sheath Diameter and Regional Cerebral Oxygen Saturation in Patients Undergoing Gynecological Laparoscopy with Total Intravenous Anesthesia"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8269-5058","authenticated-orcid":false,"given":"Chun-Gon","family":"Park","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wol-Seon","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee-Yeon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hye-Won","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4432-8510","authenticated-orcid":false,"given":"Hyun-Jeong","family":"Kwak","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9214-7039","authenticated-orcid":false,"given":"Youn-Yi","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Gil Medical Center, Gachon University, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"110156","DOI":"10.1016\/j.jclinane.2020.110156","article-title":"Lung protective ventilation strategy to reduce postoperative pulmonary complications (PPCs) in patients undergoing robot-assisted laparoscopic radical cystectomy for bladder cancer: A randomized double blinded clinical trial","volume":"71","author":"Huang","year":"2021","journal-title":"J. Clin. Anesth."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3903451","DOI":"10.1155\/2019\/3903451","article-title":"Effects of permissive hypercapnia on laparoscopic surgery for rectal carcinoma","volume":"2019","author":"Wang","year":"2019","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1097\/ALN.0b013e3181ca8257","article-title":"Effects of permissive hypercapnia on transient global cerebral ischemia-reperfusion injury in rats","volume":"112","author":"Zhou","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1001\/archsurg.1995.01430040024002","article-title":"Changes in intracranial pressure associated with apneumic retractors","volume":"130","author":"Josephs","year":"1995","journal-title":"Arch. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1177\/000313489906500215","article-title":"Central nervous system metabolic and physiologic effects of laparoscopy","volume":"65","author":"Moncure","year":"1999","journal-title":"Am. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/bja\/aeq018","article-title":"Influence of steep Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy","volume":"104","author":"Kalmar","year":"2010","journal-title":"Br. J. Anaesth."},{"key":"ref_7","unstructured":"Goetz, C.G. (2003). Textbook of Clinical Neurology, Elsevier. [2nd ed.]."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1093\/bja\/aew356","article-title":"Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods","volume":"117","author":"Robba","year":"2016","journal-title":"Br. J. Anaesth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1089\/end.2014.0019","article-title":"Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep Trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter","volume":"28","author":"Kim","year":"2014","journal-title":"J. Endourol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1177\/147323000603400511","article-title":"The effect of gynaecological laparoscopic surgery on cerebral oxygenation","volume":"34","author":"Lee","year":"2006","journal-title":"J. Int. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1097\/00000542-200011000-00012","article-title":"Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia","volume":"93","author":"McCulloch","year":"2000","journal-title":"Anesthesiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1007\/s00068-019-01249-4","article-title":"Comparison of total intravenous anesthesia vs. inhalational anesthesia on brain relaxation, intracranial pressure, and hemodynamics in patients with acute subdural hematoma undergoing emergency craniotomy: A randomized control trial","volume":"47","author":"Preethi","year":"2021","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1007\/s00134-016-4505-2","article-title":"Ventilator-related causes of lung injury: The mechanical power","volume":"42","author":"Gattinoni","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1159\/000078176","article-title":"Pulmonary consequences of a deep breath revisited","volume":"85","author":"Dietl","year":"2004","journal-title":"Biol. Neonate"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1111\/anae.13784","article-title":"Effects of acute controlled changes in end-tidal carbon dioxide on the diameter of the optic nerve sheath: A transorbital ultrasonographic study in healthy volunteer","volume":"72","author":"Dinsmore","year":"2017","journal-title":"Anaesthesia"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"114","DOI":"10.4097\/kja.19497","article-title":"Tips for troublesome sample-size calculation","volume":"73","author":"In","year":"2020","journal-title":"Korean J. Anesthesiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Yu, J., Hong, J.H., Park, J.Y., Hwang, J.H., Cho, S.S., and Kim, Y.K. (2018). Propofol attenuates the increase of sonographic optic nerve sheath diameter during robot-assisted laparoscopic prostatectomy: A randomized clinical trial. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0523-7"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e029159","DOI":"10.1136\/bmjopen-2019-029159","article-title":"Randomised controlled trial to investigate the relationship between mild hypercapnia and cerebral oxygen saturation in patients undergoing major surgery","volume":"10","author":"Wong","year":"2020","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1093\/bja\/aeu109","article-title":"Effect of ventilation on cerebral oxygenation in patients undergoing surgery in the beach chair position: A randomized controlled trial","volume":"113","author":"Murphy","year":"2014","journal-title":"Br. J. Anaesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1152\/japplphysiol.01186.2002","article-title":"Relationship between middle cerebral artery blood velocity and end-tidal PCO2 in the hypocapnic-hypercapnic range in humans","volume":"95","author":"Ide","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1152\/japplphysiol.00890.2002","article-title":"Human pulmonary vascular response to 4 h of hypercapnia and hypocapnia measured using Doppler echocardiography","volume":"94","author":"Balanos","year":"2003","journal-title":"J. Appl. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1152\/japplphysiol.90963.2008","article-title":"Extent to which pulmonary vascular responses to PCO2 and PO2 play a functional role within the healthy human lung","volume":"108","author":"Dorrington","year":"2010","journal-title":"J. Appl. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"171","DOI":"10.21037\/atm.2019.03.45","article-title":"Exploring the intraoperative lung protective ventilation of different positive end-expiratory pressure levels during abdominal laparoscopic surgery with Trendelenburg position","volume":"7","author":"Wang","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"843","DOI":"10.12659\/MSM.899801","article-title":"Effect of mild hypercapnia on lung oxygenation in sitting position during shoulder arthroscopy under general anesthesia","volume":"23","author":"Kwak","year":"2017","journal-title":"Med. Sci. Monit."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1097\/ALN.0000000000001056","article-title":"Mechanical power and development of ventilator-induced lung injury","volume":"124","author":"Cressoni","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fogagnolo, A., Montanaro, F., Al-Husinat, L., Turrini, C., Rauseo, M., Mirabella, L., Ragazzi, R., Ottaviani, I., Cinnella, G., and Volta, C. (2021). Management of intraoperative mechanical ventilation to prevent postoperative complications after general anesthesia: A narrative review. J. Clin. Med., 10.","DOI":"10.3390\/jcm10122656"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1113\/EP085403","article-title":"Exaggerated pulmonary vascular response to acute hypoxia in older men","volume":"100","author":"Balanos","year":"2015","journal-title":"Exp. Physiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"51","DOI":"10.4103\/sni.sni_403_16","article-title":"Noninvasive monitoring intracranial pressure\u2014A review of available modalities","volume":"8","author":"Khan","year":"2017","journal-title":"Surg. Neurol. Int."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1556\/APhysiol.100.2013.003","article-title":"One-lung ventilation does not result in cerebral desaturation during application of lung protective strategy if normocapnia is maintained","volume":"100","author":"Laszlo","year":"2013","journal-title":"Acta Physiol. Hung."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/20\/4707\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:12:55Z","timestamp":1760166775000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/20\/4707"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,14]]},"references-count":29,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["jcm10204707"],"URL":"https:\/\/doi.org\/10.3390\/jcm10204707","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,14]]}}}