Anesth Pain Med.  2019 Oct;14(4):393-400. 10.17085/apm.2019.14.4.393.

Optic nerve sheath diameter changes during gynecologic surgery in the Trendelenburg position: comparison of propofol-based total intravenous anesthesia and sevoflurane anesthesia

• Lee YY
• Lee H
• Park HS
• Kim WJ
• Baik HJ
• Kim DY

• KMID: 2465335
• DOI: http://doi.org/10.17085/apm.2019.14.4.393

Abstract

BACKGROUND
Elevated intracranial pressure (ICP), a disadvantage of laparoscopic or robotic surgery, is caused by the steep angle of the Trendelenburg position and the COâ‚‚ pneumoperitoneum. Recently, sonographically measured optic nerve sheath diameter (ONSD) was suggested as a simple and non-invasive method for detecting increased ICP. This study aimed to explore the changes in ONSD in relation to different anesthetic agents used in gynecologic surgery.
METHODS
Fifty patients were randomly allocated to two groups, sevoflurane (group SEV, n = 25) and propofol-based total intravenous anesthesia (TIVA) group (group TIVA, n = 25). The ONSD was measured at five time points (T0-T4): T0 was measured 5 min after induction of anesthesia in the supine position; T1, T2, and T3 were measured at 5, 15, and 30 min after COâ‚‚ pneumoperitoneum induction in the Trendelenburg position; and T4 was measured at 5 min after discontinuation of COâ‚‚ pneumoperitoneum in the supine position. Respiratory and hemodynamic variables were also recorded.
RESULTS
The intra-group changes in mean ONSD in the Trendelenburg position were significantly increased in both groups. However, inter-group changes in mean ONSD were not significantly different at T0, T1, T2, T3, and T4. Heart rates in group TIVA were significantly lower than those in group SEV at points T1-T4.
CONCLUSIONS
There was no significant difference in the ONSD between the two groups until 30 min into the gynecologic surgery with COâ‚‚ pneumoperitoneum in the Trendelenburg position. This study suggests that there is no difference in the ONSD between the two anesthetic methods.

Keyword

Gynecologic surgical procedures; Optic nerve; Propofol; Sevoflurane; Ultrasonography

MeSH Terms

Anesthesia*
Anesthesia, Intravenous*
Anesthetics
Female
Gynecologic Surgical Procedures*
Head-Down Tilt*
Heart Rate
Hemodynamics
Humans
Intracranial Hypertension
Methods
Optic Nerve*
Pneumoperitoneum
Propofol
Supine Position
Ultrasonography
Anesthetics
Propofol

Figure

• 

  Fig. 1 Consolidated standards of reporting trials flow diagram of the study. Group SEV: sevoflurane anesthesia, Group TIVA: propofol-based total intravenous anesthesia.

• 

  Fig. 2 Optic nerve sheath diameter is measured by ultrasonography. The linear probe is placed lightly over the closed upper eyelids. The diameter of the optic nerve sheath (B) is measured as 4.6 mm at a point 3.0 mm (A) behind the globe.

• 

  Fig. 3 Trends of heart rate (A), mean arterial pressure (B), peak inspiratory pressure (C), and end-tidal carbon dioxide (CO2) (D) are shown in both groups. Group SEV (•): sevoflurane anesthesia, group TIVA (□): propofol-based total intravenous anesthesia. There are no significant differences between the two groups except in heart rate. Heart rate in group TIVA was significantly lower than that in group SEV at T1–T4. T0 = 5 min after induction of anesthesia in supine position; T1, T2, and T3 = 5, 15, and 30 min after CO2 pneumoperitoneum in the Trendelenburg position; T4 = 5 min after CO2 discontinuation in the supine position. HR: heart rate, MAP: mean arterial pressure, PIP: peak inspiratory pressure, ETCO2: end-tidal CO2. Changes in ONSD at each time point were compared using repeated measure of analysis of variance. *Indicates P < 0.050 between two groups; †indicates P < 0. 001 between two groups.

• 

  Fig. 4 Trends of optic nerve sheath diameter are investigated at different time intervals. Group SEV (•): sevoflurane anesthesia, group TIVA (□): propofol-based total intravenous anesthesia. The graph shows the mean values ± SD. There are no significant differences in ONSD between group SEV and group TIVA. The intra-group increase in ONSD over time is significant in both groups (P < 0.05). Changes in ONSD at each time point were compared using repeated measure of analysis of variance. ONSD: optic nerve sheath diameter; T0 = 5 min after induction of anesthesia in supine position; T1, T2, and T3 = 5, 15, and 30 min after CO2 pneumoperitoneum in the Trendelenburg position; T4 = 5 min after CO2 discontinuation in the supine position.

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