Effects of pneumoperitoneum and patient position on intracranial pressure in obese patients undergoing laparoscopic cholecystectomy: Effects of laparoscopic cholecystectomy on intracranial pressure in obese patients

Gülçin Büyükbezirci; Şule  Arıcan; Ahmet  Topal; Resul  Yılmaz; Selman  Alkan

doi:10.28982/josam.7478

Authors

Gülçin Büyükbezirci Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey https://orcid.org/0000-0002-9438-3414
Şule Arıcan Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey https://orcid.org/0000-0002-8634-1150
Ahmet Topal Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey https://orcid.org/0000-0001-9832-9741
Resul Yılmaz Necmettin Erbakan University, Meram Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey https://orcid.org/0000-0002-5527-2893
Selman Alkan Necmettin Erbakan University, Meram Faculty of Medicine, Department of General Surgery, Konya, Turkey https://orcid.org/0000-0003-2974-7610

DOI:

https://doi.org/10.28982/josam.7478

Keywords:

Optic nerve, Obesity, Laparoscopy, Cholecystectomy

Abstract

Background/Aim: Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive techniques used for intracranial pressure (ICP) measurement. ICP changes have been evaluated based on ONSD measurements during many laparoscopic surgeries. However, such analyses in the obese patient populations are limited. This study aimed at investigating the effects of pneumoperitoneum and reverse Trendelenburg and head-up position on ICP based on ONSD measurements in obese patients undergoing laparoscopic cholecystectomy.

Methods: This observational study included 60 female patients who were scheduled for laparoscopic cholecystectomy. Obese patients with a body mass index (BMI) of 30 and above were assigned to Group 1, while BMI < 30 patients were assigned to Group 2. The first ONSD measurement was performed just before insufflation (T1). The second measurement was taken 5 min after insufflation (T2), the third measurement 5 min after placing patients in the reverse Trendelenburg and head-up position (T3), and the last measurement 5 min after the deflation while the reverse Trendelenburg and head-up position was maintained (T4).

Results: ONSD measurements at the T2 and T3 time points in Group 1 patients were higher than in Group 2 patients (P = 0.012 versus P = 0.020). Both measurement values were higher in obese patients. In Group 1 patients, T2 and T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P < 0.001). No significant difference between T2 and T3 and between T1 and T4 measurements were found. In Group 2 patients, T2 measurements were significantly higher than the T1, T3, and T4 measurements, while T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T3; P = 0.022, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P = 0.048). No significant difference between T1 and T4 measurements was noted.

Conclusion: Laparoscopic cholecystectomy does not cause an increase in ICP of obese patients with limited pneumoperitoneum pressure, reverse Trendelenburg and head-up position, and controlled anesthesia.

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