Change in the optic nerve sheath diameter after deflation of a pneumatic tourniquet: a prospective observational study

Ha-Jung Kim, Yeon Ju Kim, Jiyoung Kim, Hyungtae Kim, Young-Jin Ro, Won Uk Koh, Ha-Jung Kim, Yeon Ju Kim, Jiyoung Kim, Hyungtae Kim, Young-Jin Ro, Won Uk Koh

Abstract

Applying a pneumatic tourniquet provides surgeons with a bloodless surgical field. However, application of the tourniquet induces various physiological changes. We evaluated the effect of tourniquet deflation on the intracranial pressure by using ultrasonography to measure the optic nerve sheath diameter (ONSD) in patients undergoing lower limb surgery. The ONSD was measured in 20 patients at five time points: after anesthetic induction (T0) and immediately before (T1), immediately after (T2), 5 min after (T3), and 10 min after tourniquet deflation (T4). Hemodynamic and respiratory variables were recorded. The ONSD showed significant differences at each point (P < 0.001). The ONSDs at T2 and T3 were significantly greater than that at T1 (P = 0.0007 and < 0.0001, respectively). The change in the end-tidal carbon dioxide partial pressure (EtCO2) was similar to the change in the ONSD. The change in the ONSD was significantly correlated with the change in the EtCO2 after tourniquet deflation (r = 0.484, P = 0.030). In conclusion, the ONSD, as an indicator of intracranial pressure, increased after tourniquet deflation in patients undergoing lower limb surgery. This was correlated with an increased EtCO2 and arterial carbon dioxide partial pressure.Trial registration: ClinicalTrials.gov (NCT03782077).

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Comparison of optic nerve sheath diameters (ONSDs) measured at after anesthetic induction (T0) and immediately before (T1), immediately after (T2), 5 min after (T3), and 10 min after deflation (T4). The ONSDs were significantly increased at T2 and T3 as compared with T1. The dot and error bars indicate the mean and standard deviation, respectively.
Figure 2
Figure 2
The blue lines indicate that compared of EtCO2 measured at after anesthetic induction (T0) and immediately before (T1), immediately after (T2), 5 min after (T3), and 10 min after deflation (T4). EtCO2 were moderate correlated with ONSD. The red line indicates that compared of PaCO2 measured at immediately before (T1) and at 5 min after deflation (T3).
Figure 3
Figure 3
Measurement of optic nerve sheath diameter (ONSD) by ultrasonography. The outer diameter of the optic nerve sheath was measured 3 mm behind the optic disc.

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