title: Effect of abdominal insufflation for laparoscopy on intracranial pressure.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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
  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.
authors: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Tovy Haber
authors: TH
authors: Kamine
authors: Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Efstathios
authors: E
authors: Papavassiliou
authors: Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors: Benjamin E
authors: BE
authors: Schneider
mesh_terms: D034841:Abdominal Cavity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide / Q000008:administration & dosage*; D004066:Digestive System Diseases / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007327:Insufflation / Q000379:methods*; D007427:Intracranial Pressure / Q000502:physiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011312:Pressure; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000379:methods*
chemical_list: D002245:Carbon Dioxide