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Dynamic optic nerve sheath diameter responses to short-term hyperventilation measured with sonography in patients under general anesthesia.

Kim JY, Min HG, Ha SI, Jeong HW, Seo H, Kim JU - Korean J Anesthesiol (2014)

Bottom Line: During general anesthesia, end-tidal carbon dioxide concentration (ETCO2) was decreased from 40 mmHg to 30 mmHg within 10 minutes.ONSD was significantly decreased at time-point 3 and 4, compared with 1 and 2 (P < 0.001).This finding may support that ONSD may be beneficial to close ICP monitoring in response to CO2 change.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background: Rapid evaluation and management of intracranial pressure (ICP) can help to early detection of increased ICP and improve postoperative outcomes in neurocritically-ill patients. Sonographic measurement of optic nerve sheath diameter (ONSD) is a non-invasive method of evaluating increased intracranial pressure at the bedside. In the present study, we hypothesized that sonographic ONSD, as a surrogate of ICP change, can be dynamically changed in response to carbon dioxide change using short-term hyperventilation.

Methods: Fourteen patients were enrolled. During general anesthesia, end-tidal carbon dioxide concentration (ETCO2) was decreased from 40 mmHg to 30 mmHg within 10 minutes. ONSD, which was monitored continuously in the single sonographic plane, was repeatedly measured at 1 and 5 minutes with ETCO2 40 mmHg (time-point 1 and 2) and measured again at 1 and 5 minutes with ETCO2 30 mmHg (time-point 3 and 4).

Results: The mean ± standard deviation of ONSD sequentially measured at four time-points were 5.0 ± 0.5, 5.0 ± 0.4, 3.8 ± 0.6, and 4.0 ± 0.4 mm, respectively. ONSD was significantly decreased at time-point 3 and 4, compared with 1 and 2 (P < 0.001).

Conclusions: The ONSD was rapidly changed in response to ETCO2. This finding may support that ONSD may be beneficial to close ICP monitoring in response to CO2 change.

No MeSH data available.


Related in: MedlinePlus

The change of sonographic ONSD at four specific time-points. ONSD decreased significantly between time-points 2 and 3 (P < 0.001). ONSD values at time-point 3 and 4 were significantly decreased compared with values at time-point 1 and 2. ONSD did not show differences between two time-points in the same ETCO2 level (time-point 1 vs. 2, and 3 vs. 4). ONSD: optic nerve sheath diameter, ETCO2: end-tidal carbon dioxide concentration. *P < 0.001 (compared with time-point 1 and 2).
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Figure 2: The change of sonographic ONSD at four specific time-points. ONSD decreased significantly between time-points 2 and 3 (P < 0.001). ONSD values at time-point 3 and 4 were significantly decreased compared with values at time-point 1 and 2. ONSD did not show differences between two time-points in the same ETCO2 level (time-point 1 vs. 2, and 3 vs. 4). ONSD: optic nerve sheath diameter, ETCO2: end-tidal carbon dioxide concentration. *P < 0.001 (compared with time-point 1 and 2).

Mentions: The sequential ultrasound images, which show the consistency of the sonographic plane, were obtained at four different time-points (Fig. 1). The mean ± SD of ONSD measured at four time-points were 5.0 ± 0.5, 5.0 ± 0.4, 3.8 ± 0.6, and 4.0 ± 0.4 mm (at time-point 1, 2, 3, and 4, respectively). Fig. 2 showed that ONSD was not significantly different between time-point 1 and 2, as well as time-point 3 and 4. However, ONSD decreased significantly at the time-point 3 and 4 compared with 1 and 2 (P < 0.001). ONSD was changed significantly with change of ETCO2 and was stabilized with the maintenance of ETCO2 level.


Dynamic optic nerve sheath diameter responses to short-term hyperventilation measured with sonography in patients under general anesthesia.

Kim JY, Min HG, Ha SI, Jeong HW, Seo H, Kim JU - Korean J Anesthesiol (2014)

The change of sonographic ONSD at four specific time-points. ONSD decreased significantly between time-points 2 and 3 (P < 0.001). ONSD values at time-point 3 and 4 were significantly decreased compared with values at time-point 1 and 2. ONSD did not show differences between two time-points in the same ETCO2 level (time-point 1 vs. 2, and 3 vs. 4). ONSD: optic nerve sheath diameter, ETCO2: end-tidal carbon dioxide concentration. *P < 0.001 (compared with time-point 1 and 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216785&req=5

Figure 2: The change of sonographic ONSD at four specific time-points. ONSD decreased significantly between time-points 2 and 3 (P < 0.001). ONSD values at time-point 3 and 4 were significantly decreased compared with values at time-point 1 and 2. ONSD did not show differences between two time-points in the same ETCO2 level (time-point 1 vs. 2, and 3 vs. 4). ONSD: optic nerve sheath diameter, ETCO2: end-tidal carbon dioxide concentration. *P < 0.001 (compared with time-point 1 and 2).
Mentions: The sequential ultrasound images, which show the consistency of the sonographic plane, were obtained at four different time-points (Fig. 1). The mean ± SD of ONSD measured at four time-points were 5.0 ± 0.5, 5.0 ± 0.4, 3.8 ± 0.6, and 4.0 ± 0.4 mm (at time-point 1, 2, 3, and 4, respectively). Fig. 2 showed that ONSD was not significantly different between time-point 1 and 2, as well as time-point 3 and 4. However, ONSD decreased significantly at the time-point 3 and 4 compared with 1 and 2 (P < 0.001). ONSD was changed significantly with change of ETCO2 and was stabilized with the maintenance of ETCO2 level.

Bottom Line: During general anesthesia, end-tidal carbon dioxide concentration (ETCO2) was decreased from 40 mmHg to 30 mmHg within 10 minutes.ONSD was significantly decreased at time-point 3 and 4, compared with 1 and 2 (P < 0.001).This finding may support that ONSD may be beneficial to close ICP monitoring in response to CO2 change.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background: Rapid evaluation and management of intracranial pressure (ICP) can help to early detection of increased ICP and improve postoperative outcomes in neurocritically-ill patients. Sonographic measurement of optic nerve sheath diameter (ONSD) is a non-invasive method of evaluating increased intracranial pressure at the bedside. In the present study, we hypothesized that sonographic ONSD, as a surrogate of ICP change, can be dynamically changed in response to carbon dioxide change using short-term hyperventilation.

Methods: Fourteen patients were enrolled. During general anesthesia, end-tidal carbon dioxide concentration (ETCO2) was decreased from 40 mmHg to 30 mmHg within 10 minutes. ONSD, which was monitored continuously in the single sonographic plane, was repeatedly measured at 1 and 5 minutes with ETCO2 40 mmHg (time-point 1 and 2) and measured again at 1 and 5 minutes with ETCO2 30 mmHg (time-point 3 and 4).

Results: The mean ± standard deviation of ONSD sequentially measured at four time-points were 5.0 ± 0.5, 5.0 ± 0.4, 3.8 ± 0.6, and 4.0 ± 0.4 mm, respectively. ONSD was significantly decreased at time-point 3 and 4, compared with 1 and 2 (P < 0.001).

Conclusions: The ONSD was rapidly changed in response to ETCO2. This finding may support that ONSD may be beneficial to close ICP monitoring in response to CO2 change.

No MeSH data available.


Related in: MedlinePlus