The Effect of End-tidal Carbon Dioxide Level on the Optic Nerve Sheath Diameter in Pediatric Patients

2019 ◽  
Author(s):  
Keyword(s):  
Carbon Dioxide ◽  
Optic Nerve ◽  
Pediatric Patients ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Nerve Sheath ◽  
Carbon Dioxide Level ◽  
End Tidal Carbon Dioxide ◽  
End Tidal

scholarly journals Changes in Optic Nerve Sheath Diameter in Response to Various Levels of End-Tidal Carbon Dioxide in Healthy Patients under General Anesthesia

2018 ◽  
Vol 05 (02) ◽  
pp. 94-97
Author(s):  
Indu Kapoor ◽  
Ankur Khandelwal ◽  
Charu Mahajan ◽  
Hemanshu Prabhakar ◽  
Parmod Kumar Bithal
Keyword(s):  
Carbon Dioxide ◽  
Optic Nerve ◽  
General Anesthesia ◽  
Optic Nerve Sheath Diameter ◽  
Nerve Sheath ◽  
End Tidal Carbon Dioxide ◽  
Two Measures ◽  
The Difference ◽  
End Tidal ◽  
Different Levels

Abstract Background Intracranial pressure (ICP) monitoring is an essential component in management of traumatic brain-injured (TBI) patients. While invasive techniques are associated with many complications, noninvasive nature of ultrasonographic measurement of optic nerve sheath diameter (ONSD) is now becoming popular. Carbon dioxide (CO2) alters the ICP by changing the size of cerebral vasculature. We aimed to assess the effect of (hypercarbia and hypocarbia) different levels of end-tidal carbon dioxide (EtCO2) on ONSD. Methods Thirty adult patients aged between 18 and 65 years, undergoing brachial plexus injury surgery under general anesthesia, were enrolled. Following standard anesthetic protocol, ONSD was measured at different time points of EtCO2. ONSD was measured at EtCO2 of 40 and then 30 mm Hg to assess change in ONSD due to hypocarbia (Thypocarbia). Similarly, ONSD was measured at EtCO2 of 50 mm Hg to assess change in ONSD due to hypercarbia (Thypercarbia). The mean of three ONSD values at each time point was taken as the final value. The generalized estimating equation (GEE) was used to analyze correlation between different levels of EtCO2 and ONSD. Results The calculated 95% confidence interval (CI) for the difference of two measures (Thypocarbia, EtCO2 40 and 30 mm Hg) on ONSD was −0.056 to −0.036, and the calculated CI for the difference of other two measures (Thypercarbia, EtCO2 40 and 50 mm Hg) on ONSD was 0.044 to 0.077, and thus were observed to be significant. Conclusions ONSD changes significantly in response to different EtCO2 levels in healthy non-neurosurgical patients under general anesthesia.

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 Propofol Affects Optic Nerve Sheath Diameter less than Sevoflurane during Robotic Surgery in the Steep Trendelenburg Position

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Yanghyun Kim ◽  
Seomun Choi ◽  
Sungwoo Kang ◽  
Boram Park
Keyword(s):  
Optic Nerve ◽  
Demographic Data ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Ischemic Optic Neuropathy ◽  
Trendelenburg Position ◽  
Nerve Sheath ◽  
Steep Trendelenburg Position ◽  
The Mean ◽  
End Tidal

Background. Robot-assisted laparoscopic radical prostatectomy (RLRP) can increase intracranial pressure (ICP) related to a change in position. Increasing ICP may result in various ocular complications, which are rare but serious, such as a corneal abrasion and ischemic optic neuropathy. We performed a prospective observational trial using ultrasonographic measurements to compare optic nerve sheath diameter (ONSD) related to ICP between patients who received either propofol or sevoflurane and underwent RLRP. Methods. Thirty-two male patients scheduled to undergo RLRP were assigned into groups according to the anesthetic agent used (group P: propofol, n = 16; group S: sevoflurane, n = 16). ONSD, end-tidal partial pressure of CO2, and blood pressure were measured 10 min after induction of anesthesia (T0), 30 min (T1), 60 min (T2), and 90 min after changing to the steep Trendelenburg position and introducing a pneumoperitoneum (T3) and 10 min after returning the patient’s position to supine (T4) during surgery. Results. No significant differences were observed in the demographic data of the patients, surgery time, or intraoperative variables, including hemodynamic and respiratory variables, at any of the time points. The mean right ONSDs in the propofol and sevoflurane groups were 37.3 and 40.1 mm at 30 min (p=0.003), respectively. The mean left ONSDs were 38.4 and 40.8 mm at 30 min (p=0.021) after changing to the Trendelenburg position. The ONSDs between the two groups were significantly different during surgery. Conclusions. ONSD increased more in the sevoflurane group than in the propofol group during RLRP. Intravenous anesthetics could alleviate the increase in ICP during RLRP.

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