Abdominal Insufflation Raises Intracranial Pressure

The use of abdominal insufflation during laparoscopic procedures could raise intracranial pressure (ICP) to dangerous levels, according to a new study. 

Researchers at Beth Israel Deaconess Medical Center (Boston, MA, USA) conducted a retrospective study of 55 patients whom underwent laparoscopic-assisted ventriculoperitoneal shunting over a four-year period; of these, nine patients had records of ICP values measured through a ventricular catheter during insufflation with carbon dioxide (CO2). The ventriculoperitoneal shunts were placed for normal pressure hydrocephalus in five patients, traumatic subdural hematoma in two, and meningioma and metastatic melanoma in one patient each.

In all, 16 ICP measurements were done at insufflation pressures of 15 mmHg in all nine patients; three had pressures recorded at 12 mmHg, three at 10 mmHg, and one at 8 mmHg. The results showed that ICP significantly increased with abdominal insufflations, and correlated with laparoscopic insufflation pressure, with the maximum ICP measured a potentially dangerous 25 cm H2O; the average increase in ICP followed the insufflation CO2 pressures. The study was published on February 12, 2014, in JAMA Surgery.

“Intracranial pressure significantly increases with abdominal insufflation and correlates with laparoscopic insufflation pressure,” concluded lead author Tovy Haber Kamine, MD, and colleagues. “Laparoscopy should be used cautiously in patients with a baseline elevated ICP or head trauma.”

Laparoscopic surgery involves insufflation of a gas (usually CO2) into the peritoneal cavity, producing a pneumoperitoneum that is maintained by a constant gas flow. The raised intra-abdominal pressure (IAP) of the pneumoperitoneum, alteration in the patient's position, direct effects of gas insufflation, and the effect of CO2 absorption cause changes in physiology, especially within the cardiovascular and respiratory systems.

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