Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position
Background: Recent reports of increased intracranial pressure (ICP) due to steep Trendelenburg (ST) position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simpl...
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Wolters Kluwer Medknow Publications
2015-01-01
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doaj-152408047f2b4c2590087c9cbb0b61602020-11-24T22:50:26ZengWolters Kluwer Medknow PublicationsSaudi Journal of Anaesthesia1658-354X2015-01-019323924610.4103/1658-354X.154693Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg positionShagun Bhatia ShahAjay Kumar BhargavaItee ChoudhuryBackground: Recent reports of increased intracranial pressure (ICP) due to steep Trendelenburg (ST) position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simple technique of ICP monitoring. Ours is one of the first instances reported of quantitative noninvasive measurement of increase in ICP with ST position by serial measurement of binocular optic nerve sheath diameter (ONSD) in patients undergoing robot assisted urological and gynecological oncosurgery. We tested whether ONSD values rose to above the upper limits of normal and for what length of time they remained elevated. Materials and Methods: Prospective, randomized, interventional, parallel group, active control study conducted on 252 American Society of Anesthesiologists I and II patients. ONSD was measured using 7.5 MHz linear ultrasound probe in supine and Trendelenburg positions. Statistics: Student′s t-test to compare the inter-group mean ONSD and the repetitive t-test for intra-group analysis. Result: Comparison of the mean ONSD values of both groups yielded a 2-tailed significance P <0.01 at all compared time points intra- and post-operatively. In Group-O (open surgery; supine position), the baseline mean bilateral ONSD was 4.36 mm, which did not show any statistically significant change throughout open surgery and postoperative period. On de-docking the robot, 6.2 mm was the mean ONSD value in Group-R (robotic group) while 4.3 mm was the corresponding value in control Group-O. Conclusion: ONSD evaluation is a simple, quick, safe, readily available, reliable, cost effective, noninvasive, potential standard of care for screening and monitoring of patients undergoing robotic surgery in ST position.http://www.saudija.org/article.asp?issn=1658-354X;year=2015;volume=9;issue=3;spage=239;epage=246;aulast=ShahOptic nerve sheath diameterraised intracranial pressurerobotic surgeryTrendelenburg position |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shagun Bhatia Shah Ajay Kumar Bhargava Itee Choudhury |
spellingShingle |
Shagun Bhatia Shah Ajay Kumar Bhargava Itee Choudhury Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position Saudi Journal of Anaesthesia Optic nerve sheath diameter raised intracranial pressure robotic surgery Trendelenburg position |
author_facet |
Shagun Bhatia Shah Ajay Kumar Bhargava Itee Choudhury |
author_sort |
Shagun Bhatia Shah |
title |
Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position |
title_short |
Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position |
title_full |
Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position |
title_fullStr |
Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position |
title_full_unstemmed |
Noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep Trendelenburg position |
title_sort |
noninvasive intracranial pressure monitoring via optic nerve sheath diameter for robotic surgery in steep trendelenburg position |
publisher |
Wolters Kluwer Medknow Publications |
series |
Saudi Journal of Anaesthesia |
issn |
1658-354X |
publishDate |
2015-01-01 |
description |
Background: Recent reports of increased intracranial pressure (ICP) due to steep Trendelenburg (ST) position causing neurological deterioration, decreased regional cerebral oxygen saturation and postoperative visual loss after robotic urological and gynecological surgeries led us to consider a simple technique of ICP monitoring. Ours is one of the first instances reported of quantitative noninvasive measurement of increase in ICP with ST position by serial measurement of binocular optic nerve sheath diameter (ONSD) in patients undergoing robot assisted urological and gynecological oncosurgery. We tested whether ONSD values rose to above the upper limits of normal and for what length of time they remained elevated. Materials and Methods: Prospective, randomized, interventional, parallel group, active control study conducted on 252 American Society of Anesthesiologists I and II patients. ONSD was measured using 7.5 MHz linear ultrasound probe in supine and Trendelenburg positions. Statistics: Student′s t-test to compare the inter-group mean ONSD and the repetitive t-test for intra-group analysis. Result: Comparison of the mean ONSD values of both groups yielded a 2-tailed significance P <0.01 at all compared time points intra- and post-operatively. In Group-O (open surgery; supine position), the baseline mean bilateral ONSD was 4.36 mm, which did not show any statistically significant change throughout open surgery and postoperative period. On de-docking the robot, 6.2 mm was the mean ONSD value in Group-R (robotic group) while 4.3 mm was the corresponding value in control Group-O. Conclusion: ONSD evaluation is a simple, quick, safe, readily available, reliable, cost effective, noninvasive, potential standard of care for screening and monitoring of patients undergoing robotic surgery in ST position. |
topic |
Optic nerve sheath diameter raised intracranial pressure robotic surgery Trendelenburg position |
url |
http://www.saudija.org/article.asp?issn=1658-354X;year=2015;volume=9;issue=3;spage=239;epage=246;aulast=Shah |
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