The effect of prolonged steep head-down laparoscopy on the optical nerve sheath diameter
- PDF / 801,180 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 92 Downloads / 151 Views
ORIGINAL RESEARCH
The effect of prolonged steep head‑down laparoscopy on the optical nerve sheath diameter Riccardo Colombo1 · Andrea Agarossi1 · Beatrice Borghi1 · Davide Ottolina1 · Paola Bergomi1 · Elisabetta Ballone1 · Caterina Minari1 · Vanessa Della Porta1 · Emanuela Menozzi1 · Stefano Figini1 · Tommaso Fossali1 · Emanuele Catena1 Received: 2 July 2019 / Accepted: 31 October 2019 © Springer Nature B.V. 2019
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 C O2 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 III; (iii) therapy with beta-blockers or diuretics; (iv) heart failure defined as NYHA class ≥ IIb; (v) diabetes with ocular (i.e. retinopathy) or neurologic (i.e. peripheral neuropathy) complications; (vi) history of cardiac surgery, thoracic surgery, suprainguinal vascular surgery, head surgery, ocular surgery, stroke, hydrocephalus, or glaucoma.
13
Journal of Clinical Monitoring and Computing
In the operating room, non-invasive blood pressure was recorded every 2.5 min, while continuous monitoring of the following was instituted: electrocardiogram (ECG), pulse oximetry, respiratory gas analysis, end-tidal carbon dioxide (EtCO2), electroencephalographic rest (RE) and state (SE) entropy. Furthermore, we studied the effect of steep Trendelenburg in 10 healthy awake volunteers. Continuous ECG, pulse oximetry, ECG derived respiratory rate, and intermittent (every 2.5 min) non-invasive blood pressure were collected during the study protocol.
2.2 Induction and maintenance of anesthesia All patients were placed supine with the surgical bed at a 0° angle (neutral position). Anesthesia was induced with propofol and remifentanil via target-controlled infusion pumps (Asena Alaris; Cardinal Health, Basingstoke, United Kingdom) using Schnider’s and Minto’s pharmacokinetic models for propofol and remifentanil respectively. The predicted effect-site concentration was initially set at 4 μg ml−1 for propofol (CEprop) and 4 ng ml−1 for remifentanil (CEremi). After loss of consciousness, oxygen was given via facemask, and muscle relaxation was induced with cis-atracurium b
Data Loading...
