Indirect Measurement of Perioperative Intracranial Pressure - Eye and Orbitary Ultrasound Utility
Journal: Advances in Medicine and Engineering Interdisciplinary Research DOI: 10.32629/ameir.v2i3.2615
Abstract
Aims: To measure changes in optic nerve diameter during lower extremity trauma surgery and to compare changes in patients under general and spinal anesthesia. Methods: A prospective observational study was conducted on 50 patients undergoing lower extremity trauma surgery, of whom 26 received general anesthesia and 24 received spinal anesthesia. Data on basic patient profile, surgery, anesthesia, and optic nerve diameter were collected before surgery, 10 minutes after dural puncture or induction of anesthesia, and 10 minutes after recovery from motor block. Descriptive statistical analysis and Spearman's index were used to study the correlation between the two groups (general and spinal anesthesia). Results: The study population consisted of 25 males and 25 females, age 63.40 ± 16.36 years, weight 77 ± 10.66 kg, duration of surgery 93.20 ± 23.659 min. 28 cases required ischemic management, duration 58.15 ± 10.57 min. Preoperative optic nerve measurements were 5.06 ± 0.89 mm in the right eye and 4.45 ± 0.7955 mm in the left eye; intraoperatively: 5.70 ± 0.77 mm in the right eye and 4.84 ± 0.75 mm in the left eye; and postoperatively: 4.91 ± 0.88 mm in the right eye and 4.46 ± 0.64 mm in the left eye. The data were similar in both groups. Preoperative (p<0.01) and postoperative data were bilaterally statistically significant between the two groups. Conclusions: The optic nerve diameter increased after both spinal and general anesthesia and it returned to preoperative data in the immediate postoperative period.
Keywords
point of care ultrasound; perioperative medicine; optic nerve sheath; intradural anesthesia
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[3] Lochner P, Falla M, Brigo F, Pohl M, Strapazzon G. Ultrasonography of the optic nerve sheath diameter for diagnosis and monitoring of acute mountain sickness: a systematic review. High Alt Med Biol, 2015;16:195-203, http://dx.doi.org/10.1089/ham.2014.1127.
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[6] Zhang X, Medow JE, Iskandar BJ, Wang F, Shokoueinejad M, Koueik J, et al. Invasive and noninvasive means of measuring intracranial pressure: a review. Physiol Meas, 2017;38:R143-82, http://dx.doi.org/10.1088/1361-6579/aa7256.
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[11] Kan KM, Brown SE, Gainsburg DM. Ocular complications in robotic-assisted prostatectomy: a review of pathophysiology and prevention. Minerva Anestesiol, 2015;81:557-66.
[12] 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;49:508-14, http://dx.doi.org/10.1016/j.annemergmed.2006.06.040.
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[14] Wang L, Feng L, Yao Y, Wang Y, Chen Y, Feng J, et al. Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population. PLoS One, 2015;10:e0117939, http://dx.doi.org/10.1371/journal.pone.0117939.
[15] Padayachy LC, Padayachy V, Galal U, Pollock T, Fieggen AG. The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children.: Part II: age-related ONSD cut-off values and patency of the anterior fontanelle. Childs Nerv Syst, 2016;32:1779-85, http://dx.doi.org/10.1007/s00381-016-3068-4.
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[18] Choi SH, Min KT, Park EK, Kim MS, Jung JH, Kim H. Ultrasonography of the optic nerve sheath to assess intracranial pressure changes after ventriculo-peritoneal shunt surgery in children with hydrocephalus: a prospective observational study. Anaesthesia, 2015;70:1268-73, http://dx. doi.org/10.1111/anae.13180.
[19] Molloy BL. Implications for postoperative visual loss: steep trendelenburg position and effects on intraocular pressure. AANA J, 2011;79:115-21. PMID: 21560974.
[20] Sujata N, Tobin R, Tamhankar A, Gautam G, Yatoo AH. A randomised trial to compare the increase in intracranial pressure as correlated with the optic nerve sheath diameter during propofol versus sevoflurane-maintained anesthesia in robot-assisted laparoscopic pelvic surgery. J Robot Surg, 2019;13:267-73, http://dx.doi.org/10.1007/s11701-018-0849-7.
[21] Kim Y, Choi S, Kang S, Park B. Propofol Affects Optic Nerve Sheath Diameter less than Sevoflurane during Robotic Surgery in the Steep Trendelenburg Position. Biomed Res Int, 2019;2019:5617815, http://dx.doi.org/10.1155/2019/5617815.
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