Observational Study of Intracranial Pressure Variation Using Ultrasonography Guided Optic Nerve Sheath Diameter in Trendelenburg Position among Major Abdominal Laparoscopic Surgery

Background: Laparoscopic surgeries are widely established due to its various benefits. It requires adequate surgical exposure that is achieved by pneumoperitoneum often combined with Trendelenburg position that collectively causes increase in intra-abdominal pressure leading to many systemic physiological consequences including increase in intracranial pressure. Noninvasive USG guided ONSD was used as their measurement correlates with invasive method in patients of neurocritical care unit. We aimed to investigate the effect of Trendelenburg position with pneumoperitoneum on ONSD to examine possible changes in ICP in patients undergoing major laparoscopic abdominal surgery.

Materials and Methods: Study included 40 patients of ASA I, II with no neurological disease undergoing major abdominal laparoscopic surgery. USG guided ONSD was measured in both eyes 3 mm behind the globe preoperatively, following induction, 3 min after Trendelenburg position and 3 min with pneumoperitoneum, 2 minutes after desufflation; other parameters observed were HR, SBP, DBP, MAP, Ppeak, and ETCO2.

Results: ONSD was significantly increased from baseline in Trendelenburg position (p < 0.001). Mean ONSD at Trendelenburg position (5.2 ± 0.8) was significantly more than that in supine position (4.7 ± 0.7). Four patients had ONSD > 5.8 mm (the cutoff value for prediction of ICP above 20 mm Hg in previous studies). Mean ONSD at Trendelenburg with pneumoperitoneum (5.6 ± 0.8) increased compared with supine position. Seventeen patients had ONSD > 5.8 mm.

Conclusions: We conclude that ONSD which reflects ICP was significantly increased from baseline in Trendelenburg’s position with pneumoperitoneum.

Publication History

Article published online:
25 March 2020