Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study
Background and Aims: Laparoscopic lower abdominal surgeries involve carbon dioxide (CO2) insufflation and Trendelenburg position. The raised intra-abdominal pressure can increase intracranial pressure (ICP) and alter cerebral blood flow. This study was conducted to determine the effect of pneumoperi...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Anaesthesiology Clinical Pharmacology |
| Subjects: | |
| Online Access: | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=3;spage=429;epage=434;aulast=Joseph |
| _version_ | 1797245345895284736 |
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| author | Anu Joseph Kaushic A Theerth Vinodan Karipparambath Aruna Palliyil |
| author_facet | Anu Joseph Kaushic A Theerth Vinodan Karipparambath Aruna Palliyil |
| author_sort | Anu Joseph |
| collection | DOAJ |
| description | Background and Aims: Laparoscopic lower abdominal surgeries involve carbon dioxide (CO2) insufflation and Trendelenburg position. The raised intra-abdominal pressure can increase intracranial pressure (ICP) and alter cerebral blood flow. This study was conducted to determine the effect of pneumoperitoneum and Trendelenburg position on ICP and cerebral perfusion pressure (CPP) measured using transcranial Doppler (TCD)
Material and Methods: A prospective observational study was conducted in 43 patients of either sex, aged between 18 and 60 years with American Society of Anesthesiologists physical status I and II, undergoing elective laparoscopic surgery in Trendelenburg position. After standard anesthesia induction, pneumoperitoneum was created to facilitate surgery, maintaining an intra-abdominal pressure of 10–15 mmHg and Trendelenburg position of 25°–30°. End-tidal carbon dioxide (EtCO2) was maintained between 30 and 35 mmHg. The ICP was assessed non-invasively using TCD-based diastolic flow velocities (FVd) and pulsatility index (PI) of middle cerebral artery. Data was represented as mean ± standard deviation and compared using paired t test. A P value of < 0.05 was considered significant.
Results: Mean ICPPI at baseline was 14.02 ± 0.89 mmHg which increased to 14.54 ± 1.21 mmHg at pneumoperitoneum and Trendelenburg position (P = 0.005). Mean ICPFVd at baseline was 6.25 ± 2.47 mmHg which increased to 8.64 ± 3.79 mmHg at pneumoperitoneum and Trendelenburg position (P < 0.001). There was no statistically significant change in the CPP or mean arterial pressure values intraoperatively.
Conclusions: Laparoscopic procedures with CO2 pneumoperitoneum in Trendelenburg position increase ICP as measured using TCD ultrasonography. The CPP was not significantly altered when EtCO2 was maintained in the range of 30–35 mmHg. |
| first_indexed | 2024-03-11T15:43:21Z |
| format | Article |
| id | doaj.art-90637fe8ac3e4911bb0881cb0674bec8 |
| institution | Directory Open Access Journal |
| issn | 0970-9185 |
| language | English |
| last_indexed | 2024-04-24T19:25:26Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Anaesthesiology Clinical Pharmacology |
| spelling | doaj.art-90637fe8ac3e4911bb0881cb0674bec82024-03-25T15:51:28ZengWolters Kluwer Medknow PublicationsJournal of Anaesthesiology Clinical Pharmacology0970-91852023-01-0139342943410.4103/joacp.joacp_531_21Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational studyAnu JosephKaushic A TheerthVinodan KaripparambathAruna PalliyilBackground and Aims: Laparoscopic lower abdominal surgeries involve carbon dioxide (CO2) insufflation and Trendelenburg position. The raised intra-abdominal pressure can increase intracranial pressure (ICP) and alter cerebral blood flow. This study was conducted to determine the effect of pneumoperitoneum and Trendelenburg position on ICP and cerebral perfusion pressure (CPP) measured using transcranial Doppler (TCD) Material and Methods: A prospective observational study was conducted in 43 patients of either sex, aged between 18 and 60 years with American Society of Anesthesiologists physical status I and II, undergoing elective laparoscopic surgery in Trendelenburg position. After standard anesthesia induction, pneumoperitoneum was created to facilitate surgery, maintaining an intra-abdominal pressure of 10–15 mmHg and Trendelenburg position of 25°–30°. End-tidal carbon dioxide (EtCO2) was maintained between 30 and 35 mmHg. The ICP was assessed non-invasively using TCD-based diastolic flow velocities (FVd) and pulsatility index (PI) of middle cerebral artery. Data was represented as mean ± standard deviation and compared using paired t test. A P value of < 0.05 was considered significant. Results: Mean ICPPI at baseline was 14.02 ± 0.89 mmHg which increased to 14.54 ± 1.21 mmHg at pneumoperitoneum and Trendelenburg position (P = 0.005). Mean ICPFVd at baseline was 6.25 ± 2.47 mmHg which increased to 8.64 ± 3.79 mmHg at pneumoperitoneum and Trendelenburg position (P < 0.001). There was no statistically significant change in the CPP or mean arterial pressure values intraoperatively. Conclusions: Laparoscopic procedures with CO2 pneumoperitoneum in Trendelenburg position increase ICP as measured using TCD ultrasonography. The CPP was not significantly altered when EtCO2 was maintained in the range of 30–35 mmHg.http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=3;spage=429;epage=434;aulast=Josephcerebral blood flowintracranial pressurelaparoscopypneumoperitoneumtranscranial dopplertrendelenburg position key messages: pneumoperitoneum in trendelenburg position increases intracranial pressure. cerebral perfusion pressure is not altered with pneumoperitoneum in trendelenburg position. |
| spellingShingle | Anu Joseph Kaushic A Theerth Vinodan Karipparambath Aruna Palliyil Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study Journal of Anaesthesiology Clinical Pharmacology cerebral blood flow intracranial pressure laparoscopy pneumoperitoneum transcranial doppler trendelenburg position key messages: pneumoperitoneum in trendelenburg position increases intracranial pressure. cerebral perfusion pressure is not altered with pneumoperitoneum in trendelenburg position. |
| title | Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study |
| title_full | Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study |
| title_fullStr | Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study |
| title_full_unstemmed | Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study |
| title_short | Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: A prospective observational study |
| title_sort | effects of pneumoperitoneum and trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler a prospective observational study |
| topic | cerebral blood flow intracranial pressure laparoscopy pneumoperitoneum transcranial doppler trendelenburg position key messages: pneumoperitoneum in trendelenburg position increases intracranial pressure. cerebral perfusion pressure is not altered with pneumoperitoneum in trendelenburg position. |
| url | http://www.joacp.org/article.asp?issn=0970-9185;year=2023;volume=39;issue=3;spage=429;epage=434;aulast=Joseph |
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