Effect of abdominal insufflation for laparoscopy on intracranial pressure.

IMPORTANCE Increased abdominal pressure may have a negative effect on intracranial pressure (ICP). Human data on the effects of laparoscopy on ICP are lacking. We retrospectively reviewed laparoscopic operations for ventriculoperitoneal shunt placement to determine the effect of insufflation on ICP. OBSERVATIONS Nine patients underwent insufflation with carbon dioxide (CO(2)) at pressures ranging from 8 to 15 mm Hg and ICP measured through a ventricular catheter. We used a paired t test to compare ICP with insufflation and desufflation. Linear regression correlated insufflation pressure with ICP. The mean ICP increase with 15-mm Hg insufflation is 7.2 (95% CI, 5.4-9.1 [P < .001]) cm H(2)O. The increase in ICP correlated with increasing insufflation pressure (P = .04). Maximum ICP recorded was 25 cm H(2)O. CONCLUSIONS AND RELEVANCE Intracranial pressure significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure. The maximum ICP measured was a potentially dangerous 25 cm H(2)O. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.

[1]  C. Halpern,et al.  Decompressive laparotomy to treat intractable cerebral hypoxia. , 2009, The Journal of trauma.

[2]  W. Gormley.  Correlation between intra-abdominal and intracranial pressure in nontraumatic brain injury , 2008 .

[3]  B. Aarabi,et al.  Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome. , 2007, The Journal of trauma.

[4]  K. Lim,et al.  Therapeutic laparoscopy for abdominal trauma , 2003, Surgical Endoscopy And Other Interventional Techniques.

[5]  P. Gorecki,et al.  Diagnostic and Therapeutic Laparoscopy for Trauma: A Technique of Safe and Systematic Exploration , 2002, Surgical laparoscopy, endoscopy & percutaneous techniques.

[6]  A. Pesenti,et al.  Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: A prospective study , 2001, Critical care medicine.

[7]  A. Marmarou,et al.  Treatment of intracranial hypertension using nonsurgical abdominal decompression. , 1999, The Journal of trauma.

[8]  R. Rosenthal,et al.  Effects of hyperventilation and hypoventilation on PaCO2 and intracranial pressure during acute elevations of intraabdominal pressure with CO2 pneumoperitoneum: large animal observations. , 1998, Journal of the American College of Surgeons.

[9]  R. Ivatury,et al.  Diagnostic and therapeutic laparoscopy for penetrating abdominal trauma: a multicenter experience. , 1997, The Journal of trauma.

[10]  J. Hiatt,et al.  Intracranial pressure. Effects of pneumoperitoneum in a large-animal model. , 1997, Surgical Endoscopy.

[11]  R. L. Fulton,et al.  A comparison of the pathophysiologic effects of carbon dioxide, nitrous oxide, and helium pneumoperitoneum on intracranial pressure. , 1996, American journal of surgery.

[12]  A. Marmarou,et al.  Effects of increased intra-abdominal pressure upon intracranial and cerebral perfusion pressure before and after volume expansion. , 1996, The Journal of trauma.

[13]  D. Morabito,et al.  Therapeutic laparoscopy in trauma. , 1995, American journal of surgery.

[14]  D. Birkett,et al.  Diagnostic laparoscopy increases intracranial pressure. , 1994, The Journal of trauma.

[15]  T. Fabian,et al.  A Prospective Analysis of Diagnostic Laparoscopy in Trauma , 1993, Annals of surgery.