Effects of low- and high-pressure carbon dioxide pneumoperitoneum on intracranial pressure during laparoscopic cholecystectomy.

Abstract

Laparoscopic surgeries are a risk factor for raised intracranial **pressure and neurological complications. Even though rare, the consequences may be severe. One hundred and one patients of laparoscopic cholecystectomy were enrolled and were randomized into two groups: low-pressure 8mm Hg (Group A) and high-pressure 14mm Hg (Group B) carbon dioxide pneumoperitoneum during surgery. Fifty patients were in group A and 51 patients were in group B. Intracranial pressure was measured by measuring the optic nerve sheath diameter (ONSD) using ultrasound examination. Baseline ONSD was recorded followed by ONSD recording at various intervals: at the induction of anesthesia; 30min, 45min, at the end of surgery; and 30min post surgery. The groups were comparable in terms of demographics and comorbidities. The mean age of group A was 45years and for group B it was 45.75years. Most common indication for surgery was symptomatic gall stone disease. Baseline ONSD in group A was 0.427 ± 0.0459mm, whereas it was 0.412 ± 0.0412mm in group B. There was a significant rise of ONSD (p < 0.05) 30min after induction of pneumoperitoneum and up to 30min post anesthesia. In the low-pressure group 7 (14%) patients had a significant rise of ICP, whereas in the high-pressure group 20 (39%) patients had a significant rise of ICP (p < 0.05). High-pressure pneumoperitoneum causes significant rise in intracranial pressure in comparison to low-pressure pneumoperitoneum during laparoscopic cholecystectomy, which can be monitored by ONSD measurement by ultrasound examination and is totally non-invasive.