Evaluation of pneumoperitoneum pressures during laparoscopic surgery on the intracranial pressure by measuring ultrasonographic optic nerve sheath diameter

Abstract

Aim:  To investigate the effect of CO2 pneumoperitoneum at two different pressures (10 mmHg and 15 mmHg) on ​​intracranial pressure (ICP) in ASA I-II-III risk patients undergoing laparoscopic cholecystectomy under general anesthesia by measuring changes in optic nerve sheath diameter (ONSD) with ocular ultrasonography.

Methods: Forty patients between the ages of 18-65, who underwent laparoscopic cholecystectomy under general anesthesia and at risk of ASA I-II-III, were included the study. Patients in group low-pressure CO2 pneumoperitoneum (Group LP) were scheduled to receive CO2 pneumoperitoneum with a pressure of 10 mmHg, and patients in group high-pressure CO2 pneumoperitoneum (Group HP) with a pressure of 15 mmHg. Optical nerve sheath diameter measurements were performed different times each groups and the obtained values ​​were evaluated statistically.

Results: There was not any significant difference between the groups in terms of age, gender, height, weight, duration of intubation, duration of anesthesia and pneumoperitoneum, using opioids and intravenous fluid. Group LP showed significant lower ocular ultrasound measurement of OSND compared Group HP within the T2 and T3 period (p=0.001).

Conclusions:   ONSD is an important indicator of the effect of increased intraabdominal pressure on ONSD and hence ICP. We found that performing low pressure, produces a lesser increase in ONSD, and we think that this will have less impact on ICP.