Intracranial pressure estimated non-invasively and postoperative outcomes in surgery in the Trendelenburg position with pneumoperitoneum

TL;DR

This paper reviews how non-invasive intracranial pressure estimation during surgery in the Trendelenburg position with pneumoperitoneum may be linked to postoperative complications like nausea and vomiting.

Contribution

The study provides a scoping review linking estimated intracranial pressure during surgery to postoperative outcomes, suggesting clinical implications.

Findings

Ten of 12 studies found a link between elevated estimated ICP and postoperative complications like PONV.

Elevated ICP during surgery may be treatable, potentially improving postoperative outcomes.

More research is needed on ICP-lowering strategies and their effects on surgical outcomes.

Abstract

Surgery in the Trendelenburg position (TP) with pneumoperitoneum (PP) is beneficial in several aspects but is associated with postoperative complications, such as postoperative nausea and vomiting (PONV). The mechanism behind this is unknown, but an increase in intracranial pressure (ICP) has been suggested. There are several studies of non-invasively estimated ICP during surgery in TP with PP. The association between perioperative estimated ICP and postoperative complications has not yet been reviewed.

We performed a scoping review of peer-reviewed clinical studies reporting on both perioperative estimation of ICP and postoperative complications in patients undergoing surgery in TP with PP. The literature search was performed in February 2025 on PubMed, CINAHL, and Web of Science.

Ten of 12 included studies suggested associations between perioperative elevation of estimated ICP and postoperative complications, most notably PONV. This may have clinical implications since elevated ICP can be treated. Future research should focus on the association between perioperative ICP estimation and postoperative complications and the effects of ICP-lowering strategies on postoperative outcomes.