scholarly journals Change in the optic nerve sheath diameter after deflation of a pneumatic tourniquet: a prospective observational study

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Ha-Jung Kim ◽  
Yeon Ju Kim ◽  
Jiyoung Kim ◽  
Hyungtae Kim ◽  
Young-Jin Ro ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Lower Limb ◽  
Optic Nerve Sheath Diameter ◽  
Carbon Dioxide Partial Pressure ◽  
Pneumatic Tourniquet ◽  
Nerve Sheath ◽  
Lower Limb Surgery ◽  
Tourniquet Deflation

AbstractApplying a pneumatic tourniquet provides surgeons with a bloodless surgical field. However, application of the tourniquet induces various physiological changes. We evaluated the effect of tourniquet deflation on the intracranial pressure by using ultrasonography to measure the optic nerve sheath diameter (ONSD) in patients undergoing lower limb surgery. The ONSD was measured in 20 patients at five time points: after anesthetic induction (T0) and immediately before (T1), immediately after (T2), 5 min after (T3), and 10 min after tourniquet deflation (T4). Hemodynamic and respiratory variables were recorded. The ONSD showed significant differences at each point (P < 0.001). The ONSDs at T2 and T3 were significantly greater than that at T1 (P = 0.0007 and < 0.0001, respectively). The change in the end-tidal carbon dioxide partial pressure (EtCO2) was similar to the change in the ONSD. The change in the ONSD was significantly correlated with the change in the EtCO2 after tourniquet deflation (r = 0.484, P = 0.030). In conclusion, the ONSD, as an indicator of intracranial pressure, increased after tourniquet deflation in patients undergoing lower limb surgery. This was correlated with an increased EtCO2 and arterial carbon dioxide partial pressure.Trial registration: ClinicalTrials.gov (NCT03782077).

scholarly journals Effects of positive end-expiratory pressure, carbon dioxide and body position on intracranial pressure measured by ultrasound assessment of optic nerve sheath diameter

2021 ◽  
Vol 74 (1-2) ◽  
pp. 45-49
Author(s):  
Adrijana Bojicic ◽  
Gordana Jovanovic ◽  
Filip Pajicic ◽  
Milanka Tatic
Keyword(s):  
Carbon Dioxide ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Body Position ◽  
Venous Pressure ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Positive End Expiratory Pressure ◽  
Nerve Sheath ◽  
Ultrasound Assessment

Introduction. The optic nerve is surrounded by layers of meninges and cerebrospinal fluid, which is why intracranial pressure affects the optic nerve sheath. Noninvasive measurement of the optic nerve sheath diameter is simple, accurate, repeatable and with minimal side effects. Effects of positive end-expiratory pressure on intracranial pressure. The application of positive end-expiratory pressure plays a significant role in improving gas exchange, but it leads to an increase in intrathoracic and central venous pressure, cerebral blood volume, reduces arterial and cerebral perfusion pressure and thus futher increases intracranial pressure. The effect of positive end-expiratory pressure depends on basal intracranial pressure and respiratory system compliance. Effects of carbon dioxide on intracranial pressure. Hypercapnia leads to cerebral vasodilatation and increases cerebral blood flow and intracranial pressure. Hypocapnia reduces intracranial pressure, but its prolonged effect may lead to cerebral ischemia. Effects of body position on intracranial pressure. Body position affects intracranial pressure, primarily by affecting cerebral venous drainage. Conclusion. Body position, application of positive end-expiratory pressure, and changes in carbon dioxide can affect intracranial pressure, which is why its monitoring is of importance. Numerous studies show that their effects on intracranial pressure can be easily monitored by ultrasound assessment of optic nerve sheath diameter.

scholarly journals To observe the changes of optic nerve sheath diameter following the use of total intravenous anaesthesia with propofol or inhalational anaesthesia with desflurane during laparoscopic surgeries

2021 ◽  
Vol 8 (4) ◽  
pp. 515-520
Author(s):  
Pratikkumar Patel ◽  
Vijay Mathur ◽  
Shruti Singhal ◽  
Durga Jethava
Keyword(s):  
Laparoscopic Surgery ◽  
Optic Nerve ◽  
Intracranial Pressure ◽  
Optic Nerve Sheath Diameter ◽  
Total Intravenous Anaesthesia ◽  
Trendelenburg Position ◽  
Intravenous Anaesthesia ◽  
Nerve Sheath ◽  
Inhalational Anaesthesia ◽  
The Mean

Optic nerve sheath diameter measurement is a simple, non-invasive and yet accurate intracranial pressure (ICP) assessment technique during laparoscopic surgery. The pneumoperitoneum induced by insufflating carbon-dioxide and steep angle of trendelenburg position is associated with physiological changes resulting in increased ICP during laparoscopic surgery. We aimed to observe the changes of ONSD (surrogate marker of ICP) following the use of total intravenous anaesthesia in comparison to desflurane during laparoscopic surgery.Patients scheduled for elective laparoscopic surgery were randomly assigned to the TIVA or DES group in this randomized study. Ultrasonographic measurements of ONSD were conducted before administration of anaesthesia (T0), 10 mins, 30 mins, 1 hr after the trendelenburg position (T1,T2,T3), 5mins after resuming the supine position (T4) and at post-anaesthetic care unit (T5). The primary outcome measure was the comparison of the mean ONSD of both the eyes of the patients of both the groups that is TIVA versus DES (inhalational anaesthetic) group.A total of 60 patients were analysed in our study. The mean ONSD value at T1, T2, T3 and T4 (for right eye p=0.002,0.001,&#60;0.01,0.03 respectively and for left eye p=0.004,&#60;0.01,&#60;0.01,0.02 respectively) were significantly lower for patients in TIVA group as compared with those in DES group.Our result suggests that TIVA may be a better option than inhalational anaesthesia to prevent rise in intracranial pressure in patients undergoing laparoscopic surgery and preventing devastating complications caused by raised intracranial pressure in succeptible patients.

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