Effect of Pneumoperitoneum and Patient Positioning on Intracranial Pressures during Laparoscopy: A Prospective Comparative Study

Abstract

Pneumoperitoneum causes an increase in ICP. The patient position, either head up or head down as in gynecologic laparoscopic procedures, further worsens ICP. ONSD does not revert back to baseline until 5 minutes after desufflation.

Regarding “Effect of Pneumoperitoneum and Patient Positioning on Intracranial Pressures during Laparoscopy: A Prospective Comparative Study”

“…We read the interesting article by Sahay et al [1] concerning the effect of a pneumoperitoneum and head positioning on intracranial pressure using optic nerve sheath diameter (ONSD) measurements [1]. This is a challenging article, but we would like to make some comments.…”

Low-Dose Mannitol Pretreatment Reduces Postoperative Nausea And Vomiting In Patients Undergoing Gynaecological Laparoscopic Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial 

“…Carbon dioxide pneumoperitoneum and Trendelenburg position are the major contributors to elevated ICP during gynecological laparoscopic surgery [17,18]. Among the many strategies available to reduce the ICP during surgery is mannitol administration [19].…”

Effects of tourniquet usage in lower extremity surgery on optic nerve sheath diameter

“…Ventriculostomy is the gold-standard technique for the direct measurement of ICP, although it has several complications, such as bleeding and infection, and requires sterile conditions (11,12). Studies in the literature address the effects of ICP on ONSD in various surgeries, such as laparoscopic surgeries, in the intensive care unit (where neurosurgery is performed), or in pain management (7,9,13). However, no study in the literature addresses the measurement of ICP change via ONSD following tourniquet deflation in surgeries of the lower extremities.…”

“…However, the clinical effectiveness of this technique is controversial since it is invasive and thus has certain risks to it, including bleeding and infection (6). Previous studies that compared optic nerve sheath diameter (ONSD) ultrasonography and invasive methods in ICP monitoring revealed a strong correlation between these two methods (7). The sheath around the optic nerve is the continuation of the dura and extends along the optic nerve within the sheath in the subarachnoid space.…”