Propofol attenuates the increase of sonographic optic nerve sheath diameter during robot-assisted laparoscopic prostatectomy: a randomized clinical trial

Jihion Yu, Jun Hyuk Hong, Jun-Young Park, Jai-Hyun Hwang, Seong-Sik Cho, Young-Kug Kim, Jihion Yu, Jun Hyuk Hong, Jun-Young Park, Jai-Hyun Hwang, Seong-Sik Cho, Young-Kug Kim

Abstract

Background: Robot-assisted laparoscopic prostatectomy (RALP) requires pneumoperitoneum and the Trendelenburg position to optimize surgical exposure, which can increase intracranial pressure (ICP). Anesthetic agents also influence ICP. We compared the effects of propofol and sevoflurane on sonographic optic nerve sheath diameter (ONSD) as a surrogate for ICP in prostate cancer patients who underwent RALP.

Methods: Thirty-six patients were randomly allocated to groups receiving propofol (propofol group, n = 18) or sevoflurane (sevoflurane group, n = 18) anesthesia. The ONSD was measured 10 min after induction of anesthesia in the supine position (T1); 5 min (T2), 30 min (T3), and 60 min (T4) after establishing pneumoperitoneum and the Trendelenburg position; and at the end of surgery after desufflation in the supine position (T5). Respiratory and hemodynamic variables were also evaluated.

Results: The ONSD was significantly different between the propofol group and the sevoflurane group at T4 (5.27 ± 0.35 mm vs. 5.57 ± 0.28 mm, P = 0.007), but not at other time points. The ONSDs at T2, T3, T4, and T5 were significantly greater than at T1 in both groups (all P < 0.001). Arterial carbon dioxide partial pressure, arterial oxygen partial pressure, peak airway pressure, plateau airway pressure, systolic blood pressure, pulse pressure variation, body temperature and regional cerebral oxygen saturation, except heart rate, were not significantly different between the two groups.

Conclusions: The ONSD was significantly lower during propofol anesthesia than during sevoflurane anesthesia 60 min after pneumoperitoneum and the Trendelenburg position, suggesting that propofol anesthesia may help minimize ICP changes in robotic prostatectomy patients.

Trial registration: Clinicaltrials.gov identifier: NCT03271502 . Registered August 31, 2017.

Keywords: Propofol; Robot-assisted laparoscopic prostatectomy; Sevoflurane; Sonographic optic nerve sheath diameter.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the Asan Medical Center Institutional Review Board (approval number: 2017–1011). Written informed consent was obtained from all patients.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram
Fig. 2
Fig. 2
Comparison of the optic nerve sheath diameters between the propofol group and the sevoflurane group at 60 min after carbon dioxide pneumoperitoneum and a steep Trendelenburg position
Fig. 3
Fig. 3
Comparisons of PaO2 (a) PaCO2 (b) peak airway pressure (c) plateau airway pressure (d systolic blood pressure (e) heart rate (f) pulse pressure variation (g) and body temperature (h) between the propofol group (blue circle) and the sevoflurane group (red circle) during robot-assisted laparoscopic prostatectomy. Note that all parameters except heart rate do not significantly differ between the two groups. PaCO2 = arterial carbon dioxide partial pressure, PaO2 = arterial oxygen partial pressure, T1 = 10 min after anesthetic induction in the supine position, T2 = 5 min after establishing carbon dioxide pneumoperitoneum and a steep Trendelenburg position, T3 = 30 min after establishing carbon dioxide pneumoperitoneum and a steep Trendelenburg position, T4 = 60 min after establishing carbon dioxide pneumoperitoneum and a steep Trendelenburg position, and T5 = at the end of surgery after desufflation of pneumoperitoneum in the supine position. * indicates P < 0.05 between the two groups; † indicates P < 0.01 between the two groups

References

    1. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int. 2001;87(4):408–410. doi: 10.1046/j.1464-410x.2001.00115.x.
    1. Rassweiler J, Hruza M, Teber D, Su LM. Laparoscopic and robotic assisted radical prostatectomy--critical analysis of the results. Eur Urol. 2006;49(4):612–624. doi: 10.1016/j.eururo.2005.12.054.
    1. Berryhill R, Jr, Jhaveri J, Yadav R, Leung R, Rao S, El-Hakim A, Tewari A. Robotic prostatectomy: a review of outcomes compared with laparoscopic and open approaches. Urology. 2008;72(1):15–23. doi: 10.1016/j.urology.2007.12.038.
    1. Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy. Minerva Anestesiol. 2012;78(5):596–604.
    1. Halverson A, Buchanan R, Jacobs L, Shayani V, Hunt T, Riedel C, Sackier J. Evaluation of mechanism of increased intracranial pressure with insufflation. Surg Endosc. 1998;12(3):266–269. doi: 10.1007/s004649900648.
    1. Park EY, Koo BN, Min KT, Nam SH. The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand. 2009;53(7):895–899. doi: 10.1111/j.1399-6576.2009.01991.x.
    1. Moss E, Price DJ. Effect of propofol on brain retraction pressure and cerebral perfusion pressure. Br J Anaesth. 1990;65(6):823–825. doi: 10.1093/bja/65.6.823.
    1. Alkire MT, Haier RJ, Barker SJ, Shah NK, Wu JC, Kao YJ. Cerebral metabolism during propofol anesthesia in humans studied with positron emission tomography. Anesthesiology. 1995;82(2):393–403. doi: 10.1097/00000542-199502000-00010.
    1. Bundgaard H, von Oettingen G, Larsen KM, Landsfeldt U, Jensen KA, Nielsen E, Cold GE. Effects of sevoflurane on intracranial pressure, cerebral blood flow and cerebral metabolism. A dose-response study in patients subjected to craniotomy for cerebral tumours. Acta Anaesthesiol Scand. 1998;42(6):621–627. doi: 10.1111/j.1399-6576.1998.tb05292.x.
    1. Matta BF, Heath KJ, Tipping K, Summors AC. Direct cerebral vasodilatory effects of sevoflurane and isoflurane. Anesthesiology. 1999;91(3):677–680. doi: 10.1097/00000542-199909000-00019.
    1. Dubost C, Le Gouez A, Jouffroy V, Roger-Christoph S, Benhamou D, Mercier FJ, Geeraerts T. Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: a pilot study. Anesthesiology. 2012;116(5):1066–1071. doi: 10.1097/ALN.0b013e318246ea1a.
    1. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4:26. doi: 10.1186/1471-2288-4-26.
    1. Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model driven infusion of propofol in children. Br J Anaesth. 1991;67(1):41–48. doi: 10.1093/bja/67.1.41.
    1. Minto CF, Schnider TW, Egan TD, Youngs E, Lemmens HJ, Gambus PL, Billard V, Hoke JF, Moore KH, Hermann DJ, et al. Influence of age and gender on the pharmacokinetics and pharmacodynamics of remifentanil. I Model development. Anesthesiol. 1997;86(1):10–23. doi: 10.1097/00000542-199701000-00004.
    1. Chin JH, Seo H, Lee EH, Lee J, Hong JH, Hwang JH, Kim YK. Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position. BMC Anesthesiol. 2015;15:43. doi: 10.1186/s12871-015-0025-9.
    1. Rehberg B, Bouillon T, Zinserling J, Hoeft A. Comparative pharmacodynamic modeling of the electroencephalography-slowing effect of isoflurane, sevoflurane, and desflurane. Anesthesiology. 1999;91(2):397–405. doi: 10.1097/00000542-199908000-00013.
    1. Chui J, Mariappan R, Mehta J, Manninen P, Venkatraghavan L. Comparison of propofol and volatile agents for maintenance of anesthesia during elective craniotomy procedures: systematic review and meta-analysis. Can J Anaesth. 2014;61(4):347–356. doi: 10.1007/s12630-014-0118-9.
    1. Talke P, Caldwell JE, Richardson CA. Sevoflurane increases lumbar cerebrospinal fluid pressure in normocapnic patients undergoing transsphenoidal hypophysectomy. Anesthesiology. 1999;91(1):127–130. doi: 10.1097/00000542-199907000-00020.
    1. Oshima T, Karasawa F, Satoh T. Effects of propofol on cerebral blood flow and the metabolic rate of oxygen in humans. Acta Anaesthesiol Scand. 2002;46(7):831–835. doi: 10.1034/j.1399-6576.2002.460713.x.
    1. Illievich UM, Petricek W, Schramm W, Weindlmayr-Goettel M, Czech T, Spiss CK. Electroencephalographic burst suppression by propofol infusion in humans: hemodynamic consequences. Anesth Analg. 1993;77(1):155-160.
    1. Van Hemelrijck J, Van Aken H, Plets C, Goffin J, Vermaut G. The effects of propofol on intracranial pressure and cerebral perfusion pressure in patients with brain tumors. Acta Anaesthesiol Belg. 1989;40(2):95–100.
    1. Mangez JF, Menguy E, Roux P. Sedation by constant-rate propofol in the head-injured patient. Preliminary results. Ann Fr Anesth Reanim. 1987;6(4):336–337. doi: 10.1016/S0750-7658(87)80055-2.
    1. Farling PA, Johnston JR, Coppel DL. Propofol infusion for sedation of patients with head injury in intensive care. A preliminary report. Anaesthesia. 1989;44(3):222–226. doi: 10.1111/j.1365-2044.1989.tb11228.x.
    1. Kahveci FS, Kahveci N, Alkan T, Goren B, Korfali E, Ozluk K. Propofol versus isoflurane anesthesia under hypothermic conditions: effects on intracranial pressure and local cerebral blood flow after diffuse traumatic brain injury in the rat. Surg Neurol. 2001;56(3):206–214. doi: 10.1016/S0090-3019(01)00555-9.
    1. Kim MS, Bai SJ, Lee JR, Choi YD, Kim YJ, Choi SH. Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol. 2014;28(7):801–806. doi: 10.1089/end.2014.0019.
    1. Whiteley JR, Taylor J, Henry M, Epperson TI, Hand WR. Detection of elevated intracranial pressure in robot-assisted laparoscopic radical prostatectomy using ultrasonography of optic nerve sheath diameter. J Neurosurg Anesthesiol. 2015;27(2):155–159. doi: 10.1097/ANA.0000000000000106.
    1. Robba C, Cardim D, Donnelly J, Bertuccio A, Bacigaluppi S, Bragazzi N, Cabella B, Liu X, Matta B, Lattuada M, et al. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure assessed using different non-invasive methods. Br J Anaesth. 2016;117(6):783–791. doi: 10.1093/bja/aew356.
    1. Fahy BG, Barnas GM, Nagle SE, Flowers JL, Njoku MJ, Agarwal M. Effects of Trendelenburg and reverse Trendelenburg postures on lung and chest wall mechanics. J Clin Anesth. 1996;8(3):236–244. doi: 10.1016/0952-8180(96)00017-7.
    1. Guerci AD, Shi AY, Levin H, Tsitlik J, Weisfeldt ML, Chandra N. Transmission of intrathoracic pressure to the intracranial space during cardiopulmonary resuscitation in dogs. Circ Res. 1985;56(1):20–30. doi: 10.1161/01.RES.56.1.20.
    1. Hariri RJ, Firlick AD, Shepard SR, Cohen DS, Barie PS, Emery JM, 3rd, Ghajar JB. Traumatic brain injury, hemorrhagic shock, and fluid resuscitation: effects on intracranial pressure and brain compliance. J Neurosurg. 1993;79(3):421–427. doi: 10.3171/jns.1993.79.3.0421.
    1. Harper AM, Glass HI. Effect of alterations in the arterial carbon dioxide tension on the blood flow through the cerebral cortex at normal and low arterial blood pressures. J Neurol Neurosurg Psychiatry. 1965;28(5):449–452. doi: 10.1136/jnnp.28.5.449.
    1. Harper AM. Physiology of cerebral bloodflow. Br J Anaesth. 1965;37:225–235. doi: 10.1093/bja/37.4.225.
    1. Lassen NA, Christensen MS. Physiology of cerebral blood flow. Br J Anaesth. 1976;48(8):719–734. doi: 10.1093/bja/48.8.719.
    1. Blecha S, Harth M, Schlachetzki F, Zeman F, Blecha C, Flora P, Burger M, Denzinger S, Graf BM, Helbig H, et al. Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45 degrees Trendelenburg position. BMC Anesthesiol. 2017;17(1):40. doi: 10.1186/s12871-017-0333-3.
    1. Geeraerts T, Merceron S, Benhamou D, Vigue B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med. 2008;34(11):2062–2067. doi: 10.1007/s00134-008-1149-x.
    1. Jun IJ, Kim M, Lee J, Park SU, Hwang JH, Hong JH, Kim YK. Effect of mannitol on Ultrasonographically measured optic nerve sheath diameter as a surrogate for intracranial pressure during robot-assisted laparoscopic prostatectomy with pneumoperitoneum and the Trendelenburg position. J Endourol. 2018; 10.1089/end.2017.0828.
    1. Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, Manley GT, Nemecek A, Newell DW, Rosenthal G, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma. 2007;24(Suppl 1):S37–S44.
    1. Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10(4):376–381. doi: 10.1197/aemj.10.4.376.
    1. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49(4):508–514. doi: 10.1016/j.annemergmed.2006.06.040.
    1. Moretti R, Pizzi B. Optic nerve ultrasound for detection of intracranial hypertension in intracranial hemorrhage patients: confirmation of previous findings in a different patient population. J Neurosurg Anesthesiol. 2009;21(1):16–20. doi: 10.1097/ANA.0b013e318185996a.
    1. Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care. 2011;15(3):506–515. doi: 10.1007/s12028-011-9606-8.
    1. Kristiansson H, Nissborg E, Bartek J, Jr, Andresen M, Reinstrup P, Romner B. Measuring elevated intracranial pressure through noninvasive methods: a review of the literature. J Neurosurg Anesthesiol. 2013;25(4):372–385. doi: 10.1097/ANA.0b013e31829795ce.
    1. Strumwasser A, Kwan RO, Yeung L, Miraflor E, Ereso A, Castro-Moure F, Patel A, Sadjadi J, Victorino GP. Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. J Surg Res. 2011;170(2):265–271. doi: 10.1016/j.jss.2011.03.009.

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