Editorial Comment on: 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 by Jun et al.

2018 ◽  
Vol 32 (7) ◽  
pp. 614-614
Author(s):  
Debra E. Morrison
Keyword(s):  
Optic Nerve ◽  
Intracranial Pressure ◽  
Editorial Comment ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Nerve Sheath

scholarly journals Effects of Increased Optic Nerve Sheath Diameter on Inadequate Emergence from Anesthesia in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2260
Author(s):  
Yu Jeong Bang ◽  
Heejoon Jeong ◽  
Burn Young Heo ◽  
Byung Seop Shin ◽  
Woo Seog Sim ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Laparoscopic Prostatectomy ◽  
Nerve Sheath ◽  
Neurologic Deficits ◽  
Steep Trendelenburg Position

(1) Background: Robot-assisted laparoscopic prostatectomy (RALP) is preferred over open prostatectomy because it offers superior surgical outcomes and better postoperative recovery. The steep Trendelenburg position and pneumoperitoneum required in Robot-assisted laparoscopic prostatectomy, however, increase intracranial pressure (ICP). The present study aimed to evaluate the effects of elevated ICP on the quality of emergence from anesthesia. (2) Methods: Sixty-seven patients undergoing RALP were enrolled. We measured optic nerve sheath diameter at four timepoints during surgery. Primary outcome was inadequate emergence in the operating room (OR). Secondary outcomes were postoperative neurologic deficits of dizziness, headache, delirium, cognitive dysfunction, and postoperative nausea and vomiting (PONV). (3) Results: A total of 69 patients were screened for eligibility and 67 patients completed the study and were included in the final analysis. After establishing pneumoperitoneum with the Trendelenburg position, ONSD increased compared to baseline by 11.4%. Of the 67 patients, 36 patients showed an increase of 10% or more in optic nerve sheath diameter (ONSD). Patients with ΔONSD ≥ 10% experienced more inadequate emergence in the OR than those with ΔONSD < 10% (47.2% vs. 12.9%, p = 0.003). However, other variables related to the quality of emergence from anesthesia did not different significantly between groups. Similarly, neurologic deficits, and PONV during postoperative day 3 showed no significant differences. (4) Conclusions: ICP elevation detected by ultrasonographic ONSD measurement was associated with a transient, inadequate emergence from anesthesia.

scholarly journals Comparison of the effects of normal and low blood pressure regulation on the optic nerve sheath diameter in robot assisted laparoscopic radical prostatectomy

2021 ◽  
Author(s):  
Ji Hoon Park ◽  
Ji Hee Hong ◽  
Ji Seob Kim ◽  
Hyung Jun Kim
Keyword(s):  
Blood Pressure ◽  
Optic Nerve ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Pressure Group ◽  
Robot Assisted ◽  
Trendelenburg Position ◽  
Pressure Groups ◽  
Nerve Sheath ◽  
Low Blood Pressure

Background: Robot-assisted laparoscopic radical prostatectomy is an advanced and popular surgical technique. However, increased intracranial pressure which is caused by CO2 pneumoperitoneum and Trendelenburg position is the main cerebrovascular effect. Measurement of optic nerve sheath diameter using ocular ultrasound is a noninvasive and reliable method for the assessment of intracranial pressure. The primary endpoint of this study was to identify whether low blood pressure regulation has any benefit in attenuating an increase of optic nerve sheath diameter during robot-assisted laparoscopic radical prostatectomy.Methods: Optic nerve sheath diameter and cerebral oxygen saturation were measured at baseline (supine position), one and two hours after pneumoperitoneum and Trendelenburg position respectively, and after return to supine position in normal (n = 27) and low blood pressure groups (n = 24).Results: Mean optic nerve sheath diameter values measured at one and two hours after pneumoperitoneum and Trendelenburg position were significantly increased compared to the baseline value (P < 0.001 in normal blood pressure group; P = 0.003 in low blood pressure group). However, the mean optic nerve sheath diameter and cerebral oxygen saturation measured at any of the time points as well as degrees of change between the two groups did not show any significant changes. The peak values of optic nerve sheath diameter in normal and low blood pressure groups demonstrated 14.9% and 9.2% increases, respectively.Conclusions: Low blood pressure group demonstrated an effect in maintaining an increase of optic nerve sheath diameter less than 10% during CO2 pneumoperitoneum and Trendelenburg position.

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