Elevated Intracranial Pressure and Cerebral Ischemia

In a small study of pigs insufflated with CO2 at a pressure of 15 mmHg, the intracranial pressure increased by 5 mmHg (169). In two myelomeningocele patients with ventriculoperitoneal shunts, the intracranial pressure increased more than 15 mmHg above baseline during a CO2 pneumoperitoneum of 10 mmHg pressure only (170). In another study of 18 patients with ventriculoperitoneal shunts undergoing 19 laparo-scopic procedures, however, bradycardia and hypertension, which would be expected if the intracranial pressure increase is clinically significant, were not observed (171). Cerebral vascular engorgement is the probable mechanism of increased intracranial pressure during laparoscopy, although in patients with ven-triculoperitoneal shunts, obstruction of the catheter may play a role as well. Patients with significant cerebral vascular disease could suffer ischemia because the cerebral circulation responds to the increased intracranial volume and pressure with a decrease in blood flow (172).

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