Effects of Increased Intra-abdominal Pressure upon Intracranial and Cerebral Perfusion Pressure before and after Volume Expansion

Bloomfield, Geoffrey L.; Ridings, Philip C.; Blocher, Charles R.; Marmarou, Anthony; Sugerman, Harvey J.

doi:10.1097/00005373-199606000-00012

Cited by 165 publications

(68 citation statements)

References 29 publications

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“…The increased pleural pressure impedes venous return from the brain, leading to an increased intracranial pressure. 42,43 The authors recognize that the data in this study do not prove causality between an increased intraabdominal pressure and the presumed pressure-related co-morbidities. Our previous study found an increased sagittal abdominal pressure and urinary bladder pressure in severely obese individuals and hypothesized a relationship between these phenomena and obesityrelated co-morbidity.…”

Section: Discussionmentioning

confidence: 73%

Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity

et al. 1998

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OBJECTIVE: Evaluate the effects of surgically induced weight loss on intra-abdominal pressure at one year, re¯ected in urinary bladder pressure, central obesity, measured by sagittal abdominal diameter and obesity co-morbidity. DESIGN: Prospective, non-randomized trial. SETTING: University Hospital, Operating Room, In-patient, Outpatient Clinics. SUBJECTS: Gastric bypass in 15 severely obese patients. MEASUREMENTS: Patients underwent pre-operative assessment of weight, body mass index (BMI), co-morbid history, urinary bladder pressure and sagittal abdominal diameter. Patients were reassessed one year after gastric bypass with repeat measurement of weight, bladder pressure, and sagittal abdominal diameter and assessment of co-morbidity. RESULTS: There were signi®cant (P`0.001) decreases in weight (140 AE 8±87 AE 6 kg), BMI (52 AE 3±33 AE 2 kg/m 2 ), sagittal abdominal diameter (32 AE 1±20 AE 2 cm), urinary bladder pressure (17 AE 2±10 AE 1 cm H 2 O) and obesity related problems per patient (2.9 AE 0.4±1 AE 0.2) one year after gastric bypass, with 69 AE 4% loss of excess weight. CONCLUSIONS: Increased sagittal abdominal diameter is associated with increased intra-abdominal pressure which contributes to obesity related co-morbidity. Weight loss following gastric bypass decreases abdominal pressure, sagittal abdominal diameter and obesity co-morbidity.

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Section: Discussionmentioning

confidence: 73%

Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity

et al. 1998

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“…Morbidly obese patients have signi®cantly higher intraabdominal pressures than nonobese patients, and have a higher incidence of IIH. 20 These authors evaluated the relationship between increased intraabdominal pressures, intracranial pressure and cerebral perfusion pressure 21 and in a later study 20 suggested that increased intraabdominal pressure produced raised intracranial pressure by raising the diaphragm and increasing intrathoracic pressure, thereby reducing cerebral venous return to the heart via the jugular vein system. This in turn would obstruct cerebral venous out¯ow, raise cerebral blood volume and increase intracranial pressure by preventing normal cerebrospinal¯uid absorption.…”

Section: Pathophysiologymentioning

confidence: 99%

The relationship between obesity and idiopathic intracranial hypertension

Rowe

1999

Int J Obes

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OBJECTIVES: To evaluate the association between obesity and idiopathic intracranial hypertension (IIH) and establish whether there is a relationship with visual outcome. To calculate the prevalence and degree of obesity in a group of patients with IIH. METHODS: 34 patients (31 female and 3 male) were recruited between 1993 ± 1997 with a diagnosis of IIH. Assessment included visual acuity, visual ®eld assessment (Humphrey automated and Goldmann manual perimetry), fundus assessment and measurement of body mass index (BMI). Obesity was de®ned as a BMI of 30 kgam 2 . RESULTS: 70.5% of patients were obese. The relative risk for obesity and IIH was signi®cant at 8 (95%CI: 2,29). This increased to 17 (95%CI: 5,62) for obese females aged 16 to 24 years and 10 (95%CI: 3,35.5) for obese females aged 25 to 34 years. Morbid obesity (BMI b 40) was signi®cantly associated with poor visual outcome. Serial obesity measures showed generally little change in weight over time and there was no correlation between weight change and visual improvement. CONCLUSIONS: This study has documented a relationship between obesity and IIH. A high degree of obesity was associated with a poor visual function and identi®ed as a risk factor for poor outcome. Obesity may be an aetiological factor in this condition although it is unlikely to be the sole cause but more probably a precipitating factor. Weight loss is recommended although failure to lose weight is common. Any weight reduction programme must therefore be actively encouraged and monitored.

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“…Regional perfusion (brain, kidney, liver, and bowel) may also be affected by the rise of IAP (LE 1b) [390]; these changes should especially be considered in patients with impaired hepatic and/or renal function or modified cerebral hemodynamics (LE 5) [391]. According to previous data, the IAP level should be as low as possible in critically ill patients undergoing laparoscopic surgery for abdominal urgencies.…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

Laparoscopic approach to acute abdomen from the Consensus Development Conference of the Società Italiana di Chirurgia Endoscopica e nuove tecnologie (SICE), Associazione Chirurghi Ospedalieri Italiani (ACOI), Società Italiana di Chirurgia (SIC), Società Italiana di Chirurgia d’Urgenza e del Trauma (SICUT), Società Italiana di Chirurgia nell’Ospedalità Privata (SICOP), and the European Association for Endoscopic Surgery (EAES)

et al. 2012

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Background In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. Methods Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association.

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Effects of Increased Intra-abdominal Pressure upon Intracranial and Cerebral Perfusion Pressure before and after Volume Expansion

Abstract: Elevated IAP increases ICP and decreases CPP and cardiac index. Volume expansion further increases ICP yet improves CPP via its greater positive effect upon mean arterial pressure (*p < 0.05, analysis of variance. All measurements are mean +/- SEM in mm Hg).

Cited by 165 publications

References 29 publications

Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity

Effects of surgically induced weight loss on urinary bladder pressure, sagittal abdominal diameter and obesity co-morbidity

The relationship between obesity and idiopathic intracranial hypertension

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