EFFECT OF LOW VERSUS STANDARD PRESSURE PNEUMOPERITONEUM ON INTRACRANIAL PRESSURE USING ULTRASOUND ASSISTED OPTIC NERVE SHEATH DIAMETER IN LAPAROSCOPIC CHOLECYSTECTOMY UNDER GENERAL ANAESTHESIA
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Keywords
Pneumoperitoneum, Intracranial Pressure (ICP), Optic Nerve Sheath Diameter (ONSD), Laparoscopic Cholecystectomy, Ultrasound Monitoring
Abstract
Background- Intra‑abdominal carbondioxide insufflation is associated with an increase of intracranial pressure (ICP). This study was done to compare the impact of low versus standard pressure pneumoperitoneum on ICP through ultrasonographic estimation of optic nerve sheath diameter (ONSD). Methods-Patients in age group 20–65 years posted for laparoscopic cholecystectomy were randomly allocated into two groups:-group L (low pressure of 8–10 mmHg) and group S (standard pressure of 12–16 mmHg) on the basis of intraabdominal pressures used for surgery. General anaesthesia was administered to all patients and end‑tidal carbon dioxide (EtCO2) value was maintained in the range of 35 and 40 mmHg and peak airway pressures below 35 cmH2O. ONSD was measured in both eyes at a point 3 mm lying posterior to the globe at following time intervals:- baseline, 5 minutes (mins) after induction, 10 mins after insufflation, 10 mins after reverse trendelenberg positioning, intraoperatively during surgery and after exsufflation of gas in supine position. Results-Mean ONSD in both eyes was found to be comparable between both groups with p-values found to be significant statistically at time intervals- T insufflation, T reverse trendelenberg and T intraoperative. Heart rate and MAP values were noted to be comparable between both groups L and S with values found to be non-significant statistically at initial time intervals then becoming statistically significant intraoperatively and then again non significant after returning to baseline. Conclusion-Intraabdominal CO2 insufflation at both low and standard pressures does not elevate intracranial pressure during brief surgical procedures allowing for the safe use of either pressure in adult patients positioned in reverse trendelenberg position. The benefits of low pressure were confined to better hemodynamic control.
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Dr Anu Sharma
Associate Professor, Department of Anaesthesiology and Critical Care, Government Medical College, Amritsar
Dr Ranjana Khetarpal
Professor, Department of Anaesthesiology and Critical Care, Government Medical College, Amritsar
Dr Dheeru Marwah
Assistant Professor, Department of Anaesthesiology and Critical Care, Government Medical College, Amritsar
Dr Jagtaran Singh
Junior Resident, Department of Anaesthesiology and Critical Care, Government Medical College, Amritsar