DIAGNOSTIC LAPAROSCOPY INCREASES INTRACRANIAL-PRESSURE

There are numerous reports in the literature concerning the use of lap aroscopy for evaluation of abdominal trauma victims. The safety of lap aroscopic evaluation in trauma patients with potentially severe intrac ranial injuries has not yet been analyzed. This study investigates the effect of pneumoperitoneum on intracranial pressure (ICP) and cerebra l perfusion pressure. Five 30-kg pigs were monitored for ICP, mean art erial pressure (MAP), arterial blood gases (ABGs), and intra-abdominal pressure (IAP) for 30 minutes before, during, and after pneumoperiton eum. These series of measurements were repeated after artificially ele vating the ICP with an epidural balloon. The mean ICP at baseline was 13.46 +/- 1.01 mm Hg. The mean ICP during pneumoperitoneum was 18.72 /- 1.50 mm Hg (p = 0.0001). The ICP increased to 27.40 +/- 0.93 mm Hg (p = 0.0001) after the ICP was raised artificially to a new baseline o f 22 +/- 1.75 mm Hg with the epidural balloon. These increases were in dependent of changes in arterial PCO2 or arterial pH. Pneumoperitoneum during laparoscopy may increase ICP and must be used cautiously in ev aluating patients with severe head injuries.