The Effects of Intraperitoneal Carbon Dioxide Insufflation and Head-down Tilt Position on Intracranial Pressure

Abstract

Background: The laparoscopy requires CO₂ insufflation and posture changes for operational convenience. However, above circumstances aFfect the cardiopulmonary systems significantly. And then intracranial pressure(ICP) may be also influenced. Methods: To ascertain the changes of ICP, an experimental study was performed, in which the parameters of hemodynamic status, arterial blood gas components and ICP were measured from twelve cases of Korean mongrel dogs. Pneumoperitoneum was produced by CO₂, insufflation(15 mmHg) and then posture was altered from horizontal to head-down tilt of 20, 30 and 40 degree*. The measurements were obtained before (control), after CO₂ insufflated horizontal position at 20, 40 and 60 minute in CO insufflated tilt** and CO, deflated horizontal***. Results: MAP and HR were not related to the insufflated time and degree of tilt. CVP and PCWP were significantly increased after CO₂ insufflated tilt (p<0.0l), but retumed to control after deflated supine. PaCO₂ was not significantly changed after CO₂ insufflated supine, but grdually increased with degree of tilt and time (p<0.01). ICP was increased at 40 and 60 minute of 20, and at 20 minute of 30 (p<0.05), then markedly increased at 40 and 60 minute of 30, and at 20, 40 and 60 minute of 40 tilt (p<0.01). The increment of ICP was parallel with time and degree of tilt. But, ICP was returned to control after deflated supine. Conelusions: ICP was increased significantly during laparoscopy in head-down tilt, although it was reversible. Therefore, the patient must be given special attention during laparoscopy in whom the increment of ICP may be harmful. (Korean J Anesthesiol 1996; 31: 140-149) *; (H20, H30 and H40) **; (T20, T40 and T60) ***; (SdT20, SdT40 and SdT60)