Abdominal insufflation for laparoscopy increases intracranial and intrathoracic pressure in human subjects

Kamine, Tovy Haber; Elmadhun, Nassrene Y.; Kasper, Ekkehard M.; Papavassiliou, Efstathios

doi:10.1007/s00464-015-4715-7

Cited by 31 publications

(16 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Intracranial injuries, which are associated with blunt abdominal trauma in about 46.5% [32], constitute an additional risk especially if intracranial pressure (ICP) is elevated. Indeed, abdominal insufflation and elevated intraabdominal pressure have been shown to further increase ICP, leading to potentially worsening outcome [33–35]. Other potential limitations for laparoscopy include high-grade chest trauma, preexisting intraabdominal adhesions as well as pregnancy [36].…”

Section: For Whom?mentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

2017

View full text Add to dashboard Cite

The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.

show abstract

Section: For Whom?mentioning

confidence: 99%

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

2017

View full text Add to dashboard Cite

show abstract

“…7,18 A late chemical or arterial mechanism is related to CO 2 diffusion through the peritoneal membrane into the arterial vasculature, which results in an increase in PaCO 2 and reflex vasodilation in the central nervous system (CNS) that leads to an increase in ICP, following the Monroe-Kellie hypothesis. 5,6 The effects of elevated ICP on renal hemodynamics have been studied under experimental and clinical settings, though they remain incompletely understood. 12,16 Decreased cardiac output and increased vascular and renal resistance have been proposed as mechanisms underlying the sudden impairment of renal function following increases in IAP, though correcting cardiac output has not been found to restore normal renal function.…”

Section: Discussionmentioning

confidence: 99%

The Cushing reflex and the vasopressin-mediated hemodynamic response to increased intracranial pressure during acute elevations in intraabdominal pressure

Montorfano

Giambartolomei

Funes

et al. 2020

Surgery

View full text Add to dashboard Cite

Background: Abdominal compartment syndrome has been linked to detrimental hemodynamic side effects that include increased intracranial pressure and diminished renal function, but the mechanisms behind this continue to be elucidated. In this study, we sought to investigate any direct association between acute elevations in intra-abdominal pressure and intracranial hypertension during experimentally induced abdominal compartment syndrome and between acutely elevated intracranial pressure and the hemodynamic response that might be elicited by a vasopressin-induced Cushing reflex affecting urine osmolality and urine output. The aim of this study is to explain the Cushing reflex and the vasopressin-mediated hemodynamic response to intracranial pressure during acute elevations in intraabdominal pressure. Methods: We measured intra-abdominal pressure, intrathoracic pressure, optic nerve sheath diameter as an indirect sign of intracranial pressure, vasopressin levels in blood, urine osmolality, and urine output at 4 time points during surgery in 16 patients undergoing sleeve gastrectomy for morbid obesity. Values for the 4 time points were compared by repeated-measures analysis of variance. Results: More than 50-fold elevations in serum vasopressin paralleled increases in optic nerve sheath diameter, rising throughout prepneumoperitoneum and tapering off afterward, in conjunction with a marked decrease in urine but not serum osmolality. Mean arterial pressure rose transiently during pneumoperitoneum without elevated positive end-expiratory pressure but was not significantly elevated thereafter. Conclusions: These findings support our hypothesis that the oliguric response observed in abdominal compartment syndrome might be the result of the acutely elevated intra-abdominal pressure triggering increased intrathoracic pressure, decreased venous outflow from the central nervous system, increased intracranial pressure, and resultant vasopressin release via a Cushing reflex.

show abstract

“…En un estudio realizado por Kamine et al, se observó que las presiones intracraneales e intratorácicas estaban significativamente aumentadas durante la insuflación abdominal, aunque la presión de perfusión cerebral y la presión arterial media no se vieron afectadas. Concluyen que hay que tener especial cuidado en pacientes con ICP elevadas de base o que presenten traumatismos abdominales de gravedad 16 . Por otro lado, en un estudio realizado por Phillips et al, se evalúa el efecto protector de la presión intraperitoneal alta sobre las estructuras intraabdominales en el momento de la inserción a ciegas del primer trocar.…”

Section: Discussionunclassified

Insuflación con aguja de Veress en punto de Palmer, hasta presión intraabdominal de 25 mmHg. Técnica para mejorar la seguridad del acceso laparoscópico ginecológico.

Pantoja-Garrido

Montaño-Serrano

Frías-Sánchez

et al. 2018

Rev. chil. obstet. ginecol.

View full text Add to dashboard Cite

Objetivos: El objetivo del estudio es observar los beneficios de la entrada laparoscópica con trocar para la óptica, tras la insuflación previa con aguja de Veress en punto de Palmer, hasta conseguir una presión intraabdominal de 25 mmHg. Material y método: Estudio prospectivo de 115 cirugías laparoscópicas realizadas con la técnica anteriormente descrita, por el mismo equipo quirúrgico; de julio de 2014 a marzo de 2018, en el Departamento de Ginecología del Hospital General Santa María del Puerto. Resultados: El tiempo medio de las maniobras de acceso fue de 175 segundos. En el 84.3 % de las ocasiones, el acceso a la cavidad abdominal se consiguió en el primer intento. Sólo en dos ocasiones (1.7%), fue necesario cambiar la técnica de acceso. No se objetivó ninguna complicación o efecto adverso en el 96.5% de las cirugías. En dos pacientes (1.7%) se produjo un enfisema subcutáneo, en una ocasión un enfisema epiploico (0.9%) y en una paciente (0.9%), se objetivó una ligera intolerancia anestésica durante la realización del neumoperitoneo. No se registró durante el estudio ninguna complicación mayor asociada a las maniobras de acceso. Conclusiones: La entrada con presiones altas intraabdominales tras insuflación con aguja de Veress en punto de Palmer, es una técnica segura y reproducible para evitar complicaciones mayores, durante las maniobras de acceso a cavidad abdominal. Además, esta técnica no produce efectos adversos anestésicos relevantes secundarios a las altas presiones en pacientes sanas, debido al escaso tiempo durante el que se mantienen las mismas.

show abstract

Abdominal insufflation for laparoscopy increases intracranial and intrathoracic pressure in human subjects

Cited by 31 publications

References 22 publications

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

Laparoscopy in Blunt Abdominal Trauma: for Whom? When?and Why?

The Cushing reflex and the vasopressin-mediated hemodynamic response to increased intracranial pressure during acute elevations in intraabdominal pressure

Insuflación con aguja de Veress en punto de Palmer, hasta presión intraabdominal de 25 mmHg. Técnica para mejorar la seguridad del acceso laparoscópico ginecológico.

Contact Info

Product

Resources

About