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Brief Report | Resident's Forum

Effect of Abdominal Insufflation for Laparoscopy on Intracranial Pressure

Tovy Haber Kamine, MD1; Efstathios Papavassiliou, MD2; Benjamin E. Schneider, MD1
[+] Author Affiliations
1Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
2Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA Surg. 2014;149(4):380-382. doi:10.1001/jamasurg.2013.3024.
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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 (CO2) 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 H2O. The increase in ICP correlated with increasing insufflation pressure (P = .04). Maximum ICP recorded was 25 cm H2O.

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 H2O. Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.

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Effect of Insufflation Pressure on the Increase in Intracranial Pressure (ICP)

Intracranial pressure is measured against the desufflation baseline. Increasing insufflation pressure correlated with increased ICP (P = .04). Line indicates correlation; circles, individual patients.

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