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

Abstract

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,<0.01,0.03 respectively and for left eye p=0.004,<0.01,<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.