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Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy.

Verdonck P, Kalmar AF, Suy K, Geeraerts T, Vercauteren M, Mottrie A, De Wolf AM, Hendrickx JF - PLoS ONE (2014)

Bottom Line: The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg.Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position.These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium.

ABSTRACT

Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD) measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF) shifts becomes exhausted.

Methods: After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA I-II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP) was calculated as the mean arterial (MAP) minus central venous pressure (CVP).

Results: The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times.

Conclusion: Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.

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Evolution of ONSD over the course of the procedure.Evolution of the ONSD in individual patients (thin lines) and mean value (thick line) over the course of the procedure. *indicates significant differences with post-operative values.
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pone-0111916-g002: Evolution of ONSD over the course of the procedure.Evolution of the ONSD in individual patients (thin lines) and mean value (thick line) over the course of the procedure. *indicates significant differences with post-operative values.

Mentions: The ONSD remained constant during the entire observation period (Figure 2 and table 1). All original data is freely available for reanalysis on request.


Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy.

Verdonck P, Kalmar AF, Suy K, Geeraerts T, Vercauteren M, Mottrie A, De Wolf AM, Hendrickx JF - PLoS ONE (2014)

Evolution of ONSD over the course of the procedure.Evolution of the ONSD in individual patients (thin lines) and mean value (thick line) over the course of the procedure. *indicates significant differences with post-operative values.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4219812&req=5

pone-0111916-g002: Evolution of ONSD over the course of the procedure.Evolution of the ONSD in individual patients (thin lines) and mean value (thick line) over the course of the procedure. *indicates significant differences with post-operative values.
Mentions: The ONSD remained constant during the entire observation period (Figure 2 and table 1). All original data is freely available for reanalysis on request.

Bottom Line: The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg.Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position.These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, University Hospital Antwerp, Edegem, Belgium.

ABSTRACT

Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD) measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF) shifts becomes exhausted.

Methods: After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA I-II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP) was calculated as the mean arterial (MAP) minus central venous pressure (CVP).

Results: The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times.

Conclusion: Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.

Show MeSH
Related in: MedlinePlus