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

Ji-Hyun Chin, Hyungseok Seo, Eun-Ho Lee, Joohyun Lee, Jun Hyuk Hong, Jai-Hyun Hwang, Young-Kug Kim, Ji-Hyun Chin, Hyungseok Seo, Eun-Ho Lee, Joohyun Lee, Jun Hyuk Hong, Jai-Hyun Hwang, Young-Kug Kim

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.

Keywords: Intracranial pressure; Optic nerve sheath diameter; Trendelenburg position.

Figures

Figure 1
Figure 1
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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