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Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position.

Chin JH, Seo H, Lee EH, Lee J, Hong JH, Hwang JH, Kim YK - BMC Anesthesiol (2015)

Bottom Line: ICP can be evaluated by measuring the sonographic optic nerve sheath diameter (ONSD).Twenty-one patients scheduled for robot-assisted laparoscopic radical prostatectomy were enrolled.The ONSD in the supine position after desufflation of the pneumoperitoneum was similar to that in the supine position after induction of anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736 Republic of Korea.

ABSTRACT

Background: It remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP). ICP can be evaluated by measuring the sonographic optic nerve sheath diameter (ONSD). We investigated the effect of the isolated Trendelenburg position on ONSD in patients undergoing robot-assisted laparoscopic radical prostatectomy. Additionally, we evaluated the effect of the Trendelenburg position combined with pneumoperitoneum on ONSD.

Methods: Twenty-one patients scheduled for robot-assisted laparoscopic radical prostatectomy were enrolled. Sonographic ONSDs and hemodynamic parameters were measured at specific time points: in the supine position after induction of anesthesia, 3 min after the steep Trendelenburg position (35° incline), 3 min after the steep Trendelenburg position combined with pneumoperitoneum, and in the supine position after desufflation of the pneumoperitoneum.

Results: The ONSD 3 min after the steep Trendelenburg position was significantly higher than that of the supine position after induction of anesthesia (5.1 ± 0.3 mm vs. 4.5 ± 0.4 mm). In addition, the ONSD 3 min after the steep Trendelenburg position combined with pneumoperitoneum was higher than that of the supine position after induction of anesthesia (4.9 ± 0.4 mm vs. 4.5 ± 0.4 mm). The ONSD in the supine position after desufflation of the pneumoperitoneum was similar to that in the supine position after induction of anesthesia.

Conclusions: Use of the isolated steep Trendelenburg position, for even a short duration, increased the sonographic ONSD, providing a better understanding of the effect of only a transient steep Trendelenburg position on ONSD as a surrogate measure for ICP.

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Related in: MedlinePlus

Change in optic nerve sheath diameter (ONSD) between the supine and the steep Trendelenburg position. A significant increase was found in the ONSD 3 min after the patient position was changed from supine to steep Trendelenburg. TSUP: in the supine position after induction of anesthesia; TTREN: 3 min after the steep Trendelenburg position (35° incline).
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Fig1: Change in optic nerve sheath diameter (ONSD) between the supine and the steep Trendelenburg position. A significant increase was found in the ONSD 3 min after the patient position was changed from supine to steep Trendelenburg. TSUP: in the supine position after induction of anesthesia; TTREN: 3 min after the steep Trendelenburg position (35° incline).

Mentions: The ONSDs at several positions were significantly different from that of the supine position during surgery (P < 0.001) (Table 2). The ONSD at TTREN significantly increased compared with that at TSUP (5.1 ± 0.3 mm vs. 4.5 ± 0.4 mm; Figure 1). When patients with or without preoperative hypertension were separately considered, similar results were shown (with: 4.5 ± 0.5 mm at TSUPvs. 5.1 ± 0.3 mm at TTREN, P < 0.001; without: 4.5 ± 0.4 mm at TSUPvs. 5.0 ± 0.3 mm at TTREN, P = 0.003).Table 2


Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position.

Chin JH, Seo H, Lee EH, Lee J, Hong JH, Hwang JH, Kim YK - BMC Anesthesiol (2015)

Change in optic nerve sheath diameter (ONSD) between the supine and the steep Trendelenburg position. A significant increase was found in the ONSD 3 min after the patient position was changed from supine to steep Trendelenburg. TSUP: in the supine position after induction of anesthesia; TTREN: 3 min after the steep Trendelenburg position (35° incline).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4389861&req=5

Fig1: Change in optic nerve sheath diameter (ONSD) between the supine and the steep Trendelenburg position. A significant increase was found in the ONSD 3 min after the patient position was changed from supine to steep Trendelenburg. TSUP: in the supine position after induction of anesthesia; TTREN: 3 min after the steep Trendelenburg position (35° incline).
Mentions: The ONSDs at several positions were significantly different from that of the supine position during surgery (P < 0.001) (Table 2). The ONSD at TTREN significantly increased compared with that at TSUP (5.1 ± 0.3 mm vs. 4.5 ± 0.4 mm; Figure 1). When patients with or without preoperative hypertension were separately considered, similar results were shown (with: 4.5 ± 0.5 mm at TSUPvs. 5.1 ± 0.3 mm at TTREN, P < 0.001; without: 4.5 ± 0.4 mm at TSUPvs. 5.0 ± 0.3 mm at TTREN, P = 0.003).Table 2

Bottom Line: ICP can be evaluated by measuring the sonographic optic nerve sheath diameter (ONSD).Twenty-one patients scheduled for robot-assisted laparoscopic radical prostatectomy were enrolled.The ONSD in the supine position after desufflation of the pneumoperitoneum was similar to that in the supine position after induction of anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736 Republic of Korea.

ABSTRACT

Background: It remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP). ICP can be evaluated by measuring the sonographic optic nerve sheath diameter (ONSD). We investigated the effect of the isolated Trendelenburg position on ONSD in patients undergoing robot-assisted laparoscopic radical prostatectomy. Additionally, we evaluated the effect of the Trendelenburg position combined with pneumoperitoneum on ONSD.

Methods: Twenty-one patients scheduled for robot-assisted laparoscopic radical prostatectomy were enrolled. Sonographic ONSDs and hemodynamic parameters were measured at specific time points: in the supine position after induction of anesthesia, 3 min after the steep Trendelenburg position (35° incline), 3 min after the steep Trendelenburg position combined with pneumoperitoneum, and in the supine position after desufflation of the pneumoperitoneum.

Results: The ONSD 3 min after the steep Trendelenburg position was significantly higher than that of the supine position after induction of anesthesia (5.1 ± 0.3 mm vs. 4.5 ± 0.4 mm). In addition, the ONSD 3 min after the steep Trendelenburg position combined with pneumoperitoneum was higher than that of the supine position after induction of anesthesia (4.9 ± 0.4 mm vs. 4.5 ± 0.4 mm). The ONSD in the supine position after desufflation of the pneumoperitoneum was similar to that in the supine position after induction of anesthesia.

Conclusions: Use of the isolated steep Trendelenburg position, for even a short duration, increased the sonographic ONSD, providing a better understanding of the effect of only a transient steep Trendelenburg position on ONSD as a surrogate measure for ICP.

Show MeSH
Related in: MedlinePlus