Intra-abdominal pressure monitoring is commonly done in the operating room during laparoscopic surgery. Typically the patient’s abdomen is inflated with gas to a predetermined pressure and maintained at that pressure during the case. Though well tolerated by most patients, this pressure elevation may cause hemodynamic compromise and tissue hypoxia.[1-4]

Given our current understanding of the pathophysiology of abdominal compartment syndrome, there are other indications for intra-abdominal pressure monitoring in the operating theatre. One obvious indication is to obtain baseline IAP data on morbidly obese patients. This provides the clinician insight into the level of IAP that this patient has lived with and adapted to for a prolonged time. If the patient then becomes critically ill during the post-operative period, this baseline pressure will provide insights into when the IAP is becoming elevated.[5, 6] Another use of IAP monitoring in the operating theatre is continuous monitoring of IAP at the time of abdominal wall closure after any major laparotomy or when repairing an infants abdominal wall defect.[4, 7, 8] If the intra-abdominal pressure increases dramatically during abdominal wall closure, the surgeon might consider a staged closure to allow time for any edema to resolve. Finally, surgical procedures done in the prone position can result in elevated IAP that may lead to hemodynamic instability during the case. Intra-abdominal pressure monitoring during this situation will assist the anesthesiologist in shorting through the multiple causes of hemodynamic compromise in such cases.

1. Baroncini, S., et al., Anaesthesia for laparoscopic surgery in paediatrics. Minerva Anestesiol, 2002. 68(5): p. 406-13.
2. Chiu, A.W., et al., Effects of intra-abdominal pressure on renal tissue perfusion during laparoscopy. J Endourol, 1994. 8(2): p. 99-103.
3. Schwarte, L.A., et al., Moderate increase in intraabdominal pressure attenuates gastric mucosal oxygen saturation in patients undergoing laparoscopy. Anesthesiology, 2004. 100(5): p. 1081-7.
4. Malhotra, S.K. and D. Nakra, Detection of impending abdominal compartment syndrome. Anaesthesia, 2004. 59(11): p. 1146-7.
5. Sanchez, N.C., et al., What is normal intra-abdominal pressure? Am Surg, 2001. 67(3): p. 243-8.
6. Nguyen, N.T., et al., Evaluation of intra-abdominal pressure after laparoscopic and open gastric bypass. Obes Surg, 2001. 11(1): p. 40-5.
7. Jona, J.Z., The 'gentle touch' technique in the treatment of gastroschisis. J Pediatr Surg, 2003. 38(7): p. 1036-8.
8. Kidd, J.N., Jr., et al., Evolution of staged versus primary closure of gastroschisis. Ann Surg, 2003. 237(6): p. 759-64; discussion 764-5.