title: Low-pressure laparoscopy may ameliorate intracranial hypertension and renal hypoperfusion.
abstract: BACKGROUND
  Increased abdominal pressure is associated with elevations in the intracranial pressure (ICP) and impaired renal function. These adverse effects are potentially important in clinical situations such as severe abdominal trauma and laparoscopic donor nephrectomy. It was hypothesized that the secondary elevation of ICP leads to release of vasoconstrictors, which may affect renal function by decreasing the renal blood flow (RBF). We investigated the effect of laparoscopy on ICP and renal blood flow in a porcine model.
  
  
  METHODS
  The abdominal pressure of swine (N = 5; 20-25 kg) was gradually increased from baseline to 5, 15, and 25 mm Hg by insufflation of nitrogen into the abdominal cavity. The ICP was measured using a Camino monitor, and RBF was simultaneously measured using a Transonic Doppler probe placed on the renal artery. Results were analyzed using repeated measures ANOVA and the paired t-test.
  
  
  RESULTS
  No significant change from baseline was observed in ICP and RBF when the abdominal pressure was 5 mm Hg. However, both ICP and RBF were affected by increasing the abdominal pressure to 15 and 25 mm Hg (P = 0.035 and 0.04 for ICP and P = 0.074 and 0.034 for RBF, respectively).
  
  
  CONCLUSIONS
  Low-pressure laparoscopy may reduce the adverse effects of pneumoperitoneum on ICP and RBF. It may be advisable to use low pressures in laparoscopic surgery, especially when changes in ICP or renal perfusion may have significant clinical implications.
authors.affiliation: Department of Surgery, Cleveland Clinic Florida, Fort Lauderdale, USA. drosin6424@aol.com
authors.forename: Danny
authors.initials: D
authors.lastname: Rosin
authors.forename: Oscar
authors.initials: O
authors.lastname: Brasesco
authors.forename: Javier
authors.initials: J
authors.lastname: Varela
authors.forename: Alan A
authors.initials: AA
authors.lastname: Saber
authors.forename: Seong
authors.initials: S
authors.lastname: You
authors.forename: Raul J
authors.initials: RJ
authors.lastname: Rosenthal
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Cohn
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D019586:Intracranial Hypertension / Q000503:physiopathology* / Q000517:prevention & control; D007427:Intracranial Pressure / Q000502:physiology; D010535:Laparoscopy / Q000379:methods*; D009584:Nitrogen / Q000008:administration & dosage; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D012079:Renal Circulation / Q000502:physiology*; D013552:Swine
chemical_list: D009584:Nitrogen