The effect of lower intra-abdominal pressure on intracranial pressure measured by optic nerve sheath diameter during laparoscopic surgery

Özet

The aim of this study was to show different optic nerve sheath diameters (ONSD) using ultrasonography under different intra-abdominal pressures (IAPs) and to investigate the association between intracranial pressure (ICP) elevation and perioperative hemodynamic parameters. One hundred patients aged 18-80 years with ASA scores I&II were included. All patients received the same anesthesia protocol and were divided into two groups depending on their IAP, Group A (10 mmHg) and Group B (15 mmHg). ONSD, peak (Ppeak) and plateau (Pplateau) airway pressures, end-tidal volume carbon dioxide (ETCO2 ), heart rate (HR), and mean arterial blood pressure (MAP) were measured before pneumoperitoneum (T0), at the 10th minute of pneumoperitoneum (T1), and at the end of pneumoperitoneum (T2). No differences were determined between the groups in terms of age, gender, anthropometric measurements, ASA scores, underlying disorders, or duration of pneumoperitoneum, surgery, and anesthesia. Group B patients had higher ONSD values at T2 than Group A (5.0±0.2 vs 5.2±0.2) (p<0.001). MAP at T2 was higher in Group B than in Group A (91.5±9.5 vs 98.4±12.0) (p=0.001). HR values were higher in Group A than Group B at all time points (p˂0.001, p˂0.001, and p=0.001, respectively). Ppeak, Pplateau, and ETCO2 values at T1 and T2 were higher in Group B than Group A. The results of this study revealed that IAP affects ONSD, MAP, HR, Ppeak, Pplateau, and ETCO2. ONSD increased from commencement of pneumoperitoneum. Higher IAP resulted in higher ONSD, and thus in increased ICP, which should be noted by surgeons and anesthesiologists.