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Korean Journal of Anesthesiology 1996;31(2):140-149.
DOI: https://doi.org/10.4097/kjae.1996.31.2.140   
The Effects of Intraperitoneal Carbon Dioxide Insufflation and Head-down Tilt Position on Intracranial Pressure.
Hoo Jeon Lee, Taek Hoon Oh, Sun Gyoo Park
1Department of Anesthesiology, Kwang Myung Sung Ae General Hospital, Kyung Gi Do, Korea.
2Department of College of Medicine, Chung Ang University, Seoul, Korea.
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 CO2 insufflated tilt** and CO2 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<0.01), but returned 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 20degree, and at 20 minute of 30degree(p<0.05), then markedly increased at 40 and 60 minute of 30degree, and at 20, 40 and 60 minute of 40degreetilt (p<0.01). The increment of ICP was parallel with time and degree of tilt. But, ICP was returned to control after deflated supine.
CONCLUSIONS
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.
Key Words: Monitoring intracranial pressure; Position head-down tilt; Surgery laparoscopy; CO2 insufflation


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