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Journal of Clinical Monitoring and Computing

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01-12-2020 | Ultrasound | Original Research

The effect of prolonged steep head-down laparoscopy on the optical nerve sheath diameter

Authors: Riccardo Colombo, Andrea Agarossi, Beatrice Borghi, Davide Ottolina, Paola Bergomi, Elisabetta Ballone, Caterina Minari, Vanessa Della Porta, Emanuela Menozzi, Stefano Figini, Tommaso Fossali, Emanuele Catena

Published in: Journal of Clinical Monitoring and Computing | Issue 6/2020

Abstract

Both the steep head-down position and pneumoperitoneum increase the intracranial pressure (ICP), and their combination for a prolonged period during laparoscopic radical prostatectomy (LRP) might influence the central nervous system homeostasis. Changes in optic nerve sheath diameter (ONSD) may reflect those in ICP. This study aims to quantify the change in ONSD in response to peritoneal CO₂ insufflation and steep Trendelenburg position during LRP. ONSD was measured by ultrasound in 20 patients undergoing LRP and ten awake healthy volunteers. In patients, ONSD was assessed at baseline immediately after induction of general anesthesia in supine position, 10 and 60 min from baseline in a 25° head-down position during pneumoperitoneum, and after deflation of pneumoperitoneum with the patient supine at 0° angle. ONSD in controls was assessed at baseline with the patient lying supine, after 10 and 60 min of 25° head-down position, and 10 min after repositioning at 0° angle. ONSD increased significantly in both patients and controls (p < 0.0001) without between-group differences. The mean increase was 10.3% (95% CI 7.7–12.9%) in patients versus 7.5% (95% CI 2.5–12.6%) in controls (p = 0.28), and didn’t affect the time to recovery from anesthesia. In the studied patients, with a limited increase of end-tidal CO₂ and airway pressure, and low volume fluid infusion, the maximal ONSD was always below the cut-off value suspect for increased ICP. ONSD reflects the changes in hydrostatic pressure in response to steep Trendelenburg position, and its increase might be minimized by careful handling of general anesthesia.

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Title: The effect of prolonged steep head-down laparoscopy on the optical nerve sheath diameter
Authors: Riccardo Colombo
Andrea Agarossi
Beatrice Borghi
Davide Ottolina
Paola Bergomi
Elisabetta Ballone
Caterina Minari
Vanessa Della Porta
Emanuela Menozzi
Stefano Figini
Tommaso Fossali
Emanuele Catena
Publication date: 01-12-2020
Publisher: Springer Netherlands
Keywords: Ultrasound
Laparoscopy
Intracranial Hypertension
Ultrasound
Published in: Journal of Clinical Monitoring and Computing / Issue 6/2020
Print ISSN: 1387-1307
Electronic ISSN: 1573-2614
DOI: https://doi.org/10.1007/s10877-019-00418-5

At a glance: The STEP trials

Springer Medicine

The effect of prolonged steep head-down laparoscopy on the optical nerve sheath diameter

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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