Effects of low- and high-pressure carbon dioxide pneumoperitoneum on intracranial pressure during laparoscopic cholecystectomy

Yashwashi, T; Kaman, Lileswar; Kajal, Kamal; Dahiya, Divya; Gupta, Amod; Meena, Shyam Charan; Singh, Khomdram Jolson; Reddy, Abhinaya

doi:10.1007/s00464-019-07207-w

Cited by 13 publications

(9 citation statements)

References 15 publications

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“…The creation of pneumoperitoneum in laparoscopic cholecystectomies and other laparoscopic surgeries is known to increase intracranial pressure. 8 , 9 Increases in intra-abdominal and intrathoracic pressures due to pneumoperitoneum prevent systemic venous return and cerebral venous blood flow, which lead to an increase in intracranial pressure. 8 In addition, diffusion of CO 2 gas from the peritoneum into the vascular system during pneumoperitoneum causes reflex arterial vasodilation in the central nervous system, further increasing intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

“… 8 , 9 Increases in intra-abdominal and intrathoracic pressures due to pneumoperitoneum prevent systemic venous return and cerebral venous blood flow, which lead to an increase in intracranial pressure. 8 In addition, diffusion of CO 2 gas from the peritoneum into the vascular system during pneumoperitoneum causes reflex arterial vasodilation in the central nervous system, further increasing intracranial pressure. 10 , 11 Although invasive methods are used in the measurement of intracranial pressure, noninvasive methods, such as computed tomography (CT) and magnetic resonance imaging (MRI), are also frequently used.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Yanatma

Pola²,

Sayın³

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Yanatma

Pola²,

Sayın³

et al. 2023

Brazilian Journal of Anesthesiology (English Edition)

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“…Another well-studied parameter associated with ICP in laparoscopic surgeries is pneumoperitoneum pressure. A study investigating the effects of pneumoperitoneum created with 8 and 14 mmHg pressure emphasized the significance of low pressure to reduce changes in ICP [34]. The study was performed on patients undergoing laparoscopic cholecystectomy under propofol anesthesia in a 30° reverse Trendelenburg position, and ONSD measurements above 5.2 were considered a significant change, while ONSD measurements above 5.7 were considered the threshold value to terminate pneumoperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Effects of pneumoperitoneum and patient position on intracranial pressure in obese patients undergoing laparoscopic cholecystectomy

Hacıbeyoğlu¹,

Arıcan²,

Topal³

et al. 2022

J Surg Med

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Background/Aim: Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive techniques used for intracranial pressure (ICP) measurement. ICP changes have been evaluated based on ONSD measurements during many laparoscopic surgeries. However, such analyses in the obese patient populations are limited. This study aimed at investigating the effects of pneumoperitoneum and reverse Trendelenburg and head-up position on ICP based on ONSD measurements in obese patients undergoing laparoscopic cholecystectomy. Methods: This observational study included 60 female patients who were scheduled for laparoscopic cholecystectomy. Obese patients with a body mass index (BMI) of 30 and above were assigned to Group 1, while BMI < 30 patients were assigned to Group 2. The first ONSD measurement was performed just before insufflation (T1). The second measurement was taken 5 min after insufflation (T2), the third measurement 5 min after placing patients in the reverse Trendelenburg and head-up position (T3), and the last measurement 5 min after the deflation while the reverse Trendelenburg and head-up position was maintained (T4). Results: ONSD measurements at the T2 and T3 time points in Group 1 patients were higher than in Group 2 patients (P = 0.012 versus P = 0.020). Both measurement values were higher in obese patients. In Group 1 patients, T2 and T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P < 0.001). No significant difference between T2 and T3 and between T1 and T4 measurements were found. In Group 2 patients, T2 measurements were significantly higher than the T1, T3, and T4 measurements, while T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T3; P = 0.022, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P = 0.048). No significant difference between T1 and T4 measurements was noted. Conclusion: Laparoscopic cholecystectomy does not cause an increase in ICP of obese patients with limited pneumoperitoneum pressure, reverse Trendelenburg and head-up position, and controlled anesthesia.

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“…Low-pressure PP laparoscopic surgery is reported to positively affect certain factors besides pain. Studies have reported that it causes hemodynamic changes such as reduced blood pressure, heart rate, end-tidal CO 2 , and intracranial pressure [ 15 16 ]. One study reported that low PP reduces catecholamine release by pheochromocytomas and gastric mucosal oxygen saturation in patients undergoing laparoscopy [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy: a double-blind randomized controlled study

et al. 2021

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Purpose This study aims to evaluate the effect of different pneumoperitoneum pressures on postoperative pain, especially by subcategorizing the pressures into 3 groups during laparoscopic cholecystectomy (LC). Methods We conducted a prospective randomized, double-blinded study of 150 patients with benign and uncomplicated gallbladder disease. They were categorized into 3 groups. Each group (50 patients) underwent LC with different pneumoperitoneum methods: group VLP, very-low pressure (6–8 mmHg); group LP, low pressure (9–11 mmHg); and group SP, standard pressure (12–14 mmHg). The 3 groups were compared for pain intensity, duration, analgesic requirement, and complications. Results The characteristics of the patients were similar among all groups. Postoperative pain scores at each time point (1, 2, 4, 6, 12, 24, and 48 hours) were not significantly different among the 3 groups. Further, operation time, hospital stay, the number of analgesic consumption doses, and postoperative complications were not significantly different among the 3 groups. Conclusion This study demonstrates no difference in postoperative pain among various pneumoperitoneum pressures during LC. Therefore, routine use of lower-pressure pneumoperitoneum is not recommended unless in selected patients who require low-pressure pneumoperitoneum surgery.

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Effects of low- and high-pressure carbon dioxide pneumoperitoneum on intracranial pressure during laparoscopic cholecystectomy

Cited by 13 publications

References 15 publications

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Effects of pneumoperitoneum and patient position on intracranial pressure in obese patients undergoing laparoscopic cholecystectomy

Comparing postoperative pain in various pressure pneumoperitoneum of laparoscopic cholecystectomy: a double-blind randomized controlled study

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