Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model

Rosenthal, Raúl J.; Friedman, Richard L.; A, Kahn; Martz, Joseph; Thiagarajah, Somasundaram; Cohen, Douglas S.; Shi, Qiuhu; Nussbaum, Moses

doi:10.1016/s1091-255x(98)80031-0

Cited by 77 publications

(56 citation statements)

References 47 publications

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“…CO 2 increases ICP more than do helium and nitric oxide (5 [267]). Hypoventilation and hypercarbia increase ICP compared to hyperventilation and hypocarbia, but during acute elevations of ICP hyperventilation did not decrease ICP eectively (5 [251]). The insuation gas has fewer eects on ICP than on IAP (4 [74], 5 [60]).…”

Section: Intracranial Pressurementioning

confidence: 99%

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The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

et al. 2002

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Preoperatively, all patients should be assessed for the presence of cardiac, pulmonary, hepatic, renal, or vascular comorbidity. Presupposing appropriate perioperative measures and surgical technique, there is no reason to contraindicate pneumoperitoneum in patients with peritonitis or intraabdominal malignancy. During laparoscopy, monitoring of end tidal CO2 concentration is mandatory. The available data on closed- (Veress needle) and open-access techniques do not allow us to principally favor the use of either technique. Using 2 to 5-mm instead of 5 to 10-mm trocars improves cosmetic result and postoperative pain marginally. It is recommended to use the lowest intraabdominal pressure allowing adequate exposure of the operative field, rather than using a routine pressure. In patients with limited cardiac, pulmonary, or renal function, abdominal wall lifting combined with low-pressure pneumoperitoneum might be an alternative. Abdominal wall lifting devices have no clinically relevant advantages compared to low-pressure (5-7 mmHg) pneumoperitoneum. In patients with cardiopulmonary diseases, intra- and postoperative arterial blood gas monitoring is recommended. The clinical benefits of warmed, humidified insufflation gas are minor and contradictory. Intraoperative sequential intermittent pneumatic compression of the lower extremities is recommended for all prolonged laparoscopic procedures. For the prevention of postoperative pain a wide range of treatment options exists. Although all these options seem to reduce pain, the data currently do not justify a general recommendation.

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Section: Intracranial Pressurementioning

confidence: 99%

“…Furthermore, it was hypothesized that this mechanical eect leads to an increase in ICP and a central nervous system response causing systemic hypertension (5 [15,251]). However, the exact pathophysiology of increasing ICP during pneumoperitoneum remains unclear.…”

Section: Intracranial Pressurementioning

confidence: 99%

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

et al. 2002

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“…An emerging trend has been the use of low pressure pneumoperitoneum in the range of 7-10 mm Hg to lower the impact of pneumoperitoneum on the human physiology while providing adequate working space. 7 With the establishment of laparoscopic cholecystectomy as gold standard for the management of cholelithiasis, there has been a series of untiring efforts to evolve and increase its safety. The aim has been to reduce the trauma especially during access, increasing surgeon and patient satisfaction and decreasing operative difficulty during the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Various authors have reported that laparoscopic cholecystectomy performed with LPP resulted in a better postoperative quality of life as compared to laparoscopic cholecystectomy performed with HPP. [7][8][9][10][11][12][13][14][15][16][17][18] The proposed causes of post laparoscopy shoulder pain are peritoneal stretching, chemical irritation by CO2 and overstretching of diaphragmatic muscles owing to high rate of insufflation. Wallace, Kandil TS, demonstrated that the degree of stretching in the intra-abdominal cavity is a significant source of postoperative pain and it has been shown that a low insufflation rate significantly reduces shoulder tip pain.…”

Section: Discussionmentioning

confidence: 99%

Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

et al. 2017

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Background: Laparoscopic cholecystectomy is established as gold standard for management of cholelithiasis. Intraoperative pneumoperitoneum affects the postoperative outcomes. The current stress is on increasing patient safety. Hence, this prospective study was undertaken to compare the effect of low pressure pneumoperitoneum (LPP <10 mm Hg) versus high pressure pneumoperitoneum (HPP > 14 mm Hg) on postoperative pain and ileus.Methods: 120 patients undergoing laparoscopic cholecystectomy were randomized into the LPP (<10mm Hg) group (n=60) and the HPP (>14 mm Hg) group (n=60). Total duration of surgery, intra-operative gas consumption, occurrence of bile spillage during operation, shoulder pain and abdominal pain in postoperative period, additional requirement of analgesia in postoperative period and postoperative ileus were assessed.Results: There was no significant difference in terms of operative duration, consumption of CO2 gas, intraoperative bile spillage, total hospital stay and tolerance to early feeding. The incidence of shoulder pain was higher in patients who underwent HPP laparoscopic cholecystectomy (p<0.05). There was early recovery and early return of bowel activity in LPP which was statistically significant.Conclusions: Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative shoulder tip pain and near-equal operative time with early return of bowel activity compared with high-pressure pneumoperitoneum.

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“…There is considerable evidence showing in both animal [147][148][149][150][151] and human 152 studies that there is a direct relationship between steadily increasing IAP and rising Intra-cranial pressure (ICP) as well as a coincident fall in Cerebral Perfusion Pressure (CPP); effects which are mechanical in nature in accordance with the Monroe-Kellie Doctrine through increases in jugular venous and sagittal sinus pressure. This is potentially relieved by abdominal decompression as well as by central volume expansion and PEEP ventilation.…”

Section: Miscellaneous Pathophysiology and Intra-abdomi-nal Hypertensionmentioning

confidence: 99%

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

Ap¹,

Wun²,

Chiappa³

et al. 2015

Emerg Med Open J

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Abdominal Compartment Syndrome (ACS) is a potentially lethal condition caused by various events that produce intra-abdominal hypertension. The most common cause is blunt abdominal trauma. Increasing intra-abdominal pressure causes progressive hypoperfusion and ischemia of the intestines and other peritoneal and retroperitoneal structures. Pathophysiological effects include release of cytokines, production of oxygen free radicals, and decreased cellular formation of adenosine triphosphate. These processes may lead to translocation of bacteria from the gut and intestinal edema, predisposing patients to multiorgan dysfunction syndrome. The consequences of abdominal compartment syndrome are profound and affect many vital body systems. Respiratory, hemodynamic, cardiovascular, renal, and neurological abnormalities are signs of abdominal compartment syndrome. Medical management of critically ill patients with raised intra-abdominal pressure should be instigated early to prevent further organ dysfunction and to avoid progression to ACS. Many treatment options are available and are often part of routine daily management in the ICU (nasogastric, rectal tube, prokinetics, enema, sedation, body position). Some of the newer treatments are very promising options in specific patient populations with raised IAP. Nursing care involves vigilant monitoring for early detection, including serial measurements of intra-abdominal pressure.KEYWORDS: Intra-abdominal hypertension; Abdominal compartment syndrome; Damage control laparotomy; Laparostomy; Open abdomen. DEFINITIONS, INCIDENCE AND MEASUREMENT STRATEGIES IN INTRA-ABDOMINAL HY-PERTENSION (IAH) AND ABDOMINAL COMPARTMENT SYNDROME (ACS)The concept of the Abdominal Compartment Syndrome (ACS) has been rediscovered as a final common pathway of the physiologic sequelae of increased Intra-Abdominal Pressure In each case if the graph shifts to the right, higher IAP and lower APP values may not be associated with significant end-organ dysfunction creating a degree of "ACS-resistance." Shifts to the left would create "ACS-sensitivity" where lower values of IAP (higher APP values) may still be associated with organ dysfunction which might not occur normally. This results in difficulty for broader acceptance of critical IAP and APP levels for individual cases. ACS-sensitivity may potentially occur in patients where there is pre-existing partial end-organ failure, morbid obesity or following fluid hyper-resuscitation in patients with severe burns, haemorrhagic pancreatitis, massive blood loss, widespread intra-peritoneal sepsis and high-output intestinal fistulae. 6-8There is no strict definition of what represents abnormal IAP, but there is a general acceptance that measured pressures >12 mmHg when recorded 1-6 hours apart are considered to represent IAH, where Sugrue, et al. have shown that this represents up to 40% of cases admitted to a surgical Intensive Care Unit (ICU). 9 Although there are biases in the prospective assessment of a selective population admitted to an ICU who ...

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Reasons for intracranial hypertension and hemodynamic instability during acute elevations of intra-abdominal pressure: observations in a large animal model

Cited by 77 publications

References 47 publications

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery

Outcome analysis of low pressure versus high pressure pneumoperitoneum laparoscopic cholecystectomy: a randomized clinical study

Primary Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: Pathophysiology and Treatment

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