Sonographic optic nerve sheath diameter as a surrogate measure for intracranial pressure in anesthetized patients in the Trendelenburg position

Ji-Hyun Chin,Hyungseok Seo,Jun Hyuk Hong,Joohyun Lee,Eun-Ho Lee,Young-Kug Kim,Jai-Hyun Hwang

doi:10.1186/s12871-015-0025-9

Ji-Hyun Chin, Hyungseok Seo + Show 5 more

Open Access

https://doi.org/10.1186/s12871-015-0025-9

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Abstract

BackgroundIt remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP). ICP can be evaluated by measuring the sonographic optic nerve sheath diameter (ONSD). We investigated the effect of the isolated Trendelenburg position on ONSD in patients undergoing robot-assisted laparoscopic radical prostatectomy. Additionally, we evaluated the effect of the Trendelenburg position combined with pneumoperitoneum on ONSD.MethodsTwenty-one patients scheduled for robot-assisted laparoscopic radical prostatectomy were enrolled. Sonographic ONSDs and hemodynamic parameters were measured at specific time points: in the supine position after induction of anesthesia, 3 min after the steep Trendelenburg position (35° incline), 3 min after the steep Trendelenburg position combined with pneumoperitoneum, and in the supine position after desufflation of the pneumoperitoneum.ResultsThe ONSD 3 min after the steep Trendelenburg position was significantly higher than that of the supine position after induction of anesthesia (5.1 ± 0.3 mm vs. 4.5 ± 0.4 mm). In addition, the ONSD 3 min after the steep Trendelenburg position combined with pneumoperitoneum was higher than that of the supine position after induction of anesthesia (4.9 ± 0.4 mm vs. 4.5 ± 0.4 mm). The ONSD in the supine position after desufflation of the pneumoperitoneum was similar to that in the supine position after induction of anesthesia.ConclusionsUse of the isolated steep Trendelenburg position, for even a short duration, increased the sonographic ONSD, providing a better understanding of the effect of only a transient steep Trendelenburg position on ONSD as a surrogate measure for ICP.

Highlights

It remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP)
Study protocol When hemodynamically stable conditions were reached, four measurements were taken, as follows: in the supine position after induction of anesthesia (TSUP), 3 min after the steep Trendelenburg position (35° incline) (TTREN), 3 min after the steep Trendelenburg position combined with pneumoperitoneum (15 mmHg of insufflation pressure) (TT+P), and in the supine position after desufflation of the pneumoperitoneum (TEND)
There was no significant difference in mean blood pressure (MBP) between patients with and without hypertension

Summary

Introduction

It remains to be elucidated whether the Trendelenburg position increases intracranial pressure (ICP). The Trendelenburg position has long been believed to increase intracranial pressure (ICP), an idea that may be derived from previous reports [1,2]. In these studies, the ICP increased when prolonged comatose patients with severe brain injury and neurosurgical patients were placed in the head-down position [1,2]. An increased optic nerve sheath diameter (ONSD) detected by ocular sonography is associated with clinical signs of high ICP in adults with traumatic brain injury and in children with hydrocephalus or liver failure [9,10,11,12,13]. Rapid and safe sonographic measurement of ONSD may enable patients to be screened for increased ICP

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