“LAP-MAP”: A new blood pressure target during laparoscopic surgery

Prolonged laparoscopic surgery with steep Trendelenberg position is frequently requested in high risk surgical patients. The combination of prolonged laparoscopy with steep Trendelenberg positioning may alter cerebral haemodynamic parameters. Possible decreases in cerebral perfusion pressure (CPP) and cerebral blood flow across anterior and posterior cerebral circulations, where high central venous pressure (CVP) creates a ‘back-pressure’, may expose ‘watershed’ areas to hypo-perfusion despite autoregulation . An increase in intracranial pressure may also occur during prolonged steep Trendelenberg leading to temporary cerebral oedema. An increase in intra-ocular pressure has also been described . Nevertheless, it is difficult to predict how a patient’s unique physiologic and haemodynamic changes and reflexes during laparoscopy will affect cerebral perfusion.