Dexmedetomidine attenuates the increase of ultrasonographic optic nerve sheath diameter as a surrogate for intracranial pressure in patients undergoing robot-assisted laparoscopic prostatectomy

Abstract

Background:Pneumoperitoneum and steep Trendelenburg position during robot-assisted laparoscopic prostatectomy (RALP) can increase intracranial pressure (ICP). Dexmedetomidine, a highly selective alpha-2 adrenergic receptor agonist, can cause cerebral vasoconstriction and decrease cerebral blood flow by stimulating the postsynaptic alpha-2 adrenergic receptors on cerebral blood vessels. However, the effects of dexmedetomidine on ICP are controversial and have not been evaluated during RALP under the establishment of pneumoperitoneum in the steep Trendelenburg position. Therefore, we evaluated the effect of dexmedetomidine on optic nerve sheath diameter (ONSD) as a surrogate for assessing ICP during RALP.Methods:Patients were randomly allocated to receive dexmedetomidine (n = 63) (loading dose, 1 μg/kg for 10 minutes and continuous infusion, 0.4 μg/kg/hr) or normal saline (n = 63). The ONSD was measured at 10 minutes after induction of anesthesia in the supine position (T1), 30 minutes (T2) and 60 minutes (T3) after establishment of pneumoperitoneum in the steep Trendelenburg position, and at closing the skin in the supine position (T4). Hemodynamic and respiratory variables were measured at every time point.Results:ONSDs at T2, T3, and T4 were significantly smaller in the dexmedetomidine group than in the control group (5.26 ± 0.25 mm vs 5.71 ± 0.26 mm, 5.29 ± 0.24 mm vs 5.81 ± 0.23 mm, and 4.97 ± 0.24 mm vs 5.15 ± 0.28 mm, all P <.001). ONSDs at T2, T3, and T4 were significantly increased compared to T1 in both groups. Hemodynamic and respiratory variables, except heart rate, did not significantly differ between the 2 groups. The bradycardia and atropine administration were not significantly different between the 2 groups.Conclusion:Dexmedetomidine attenuates the increase of ONSD during RALP, suggesting that intraoperative dexmedetomidine administration may effectively attenuate the ICP increase during pneumoperitoneum in the Trendelenburg position.

Effect of Dexmedetomidine on Maintaining Perioperative Hemodynamic Stability in Elderly Patients: A Systematic Review and Meta-analysis

“…HR and MAP of patients in surgical intensive care unit after major abdominal surgery were significantly lower in the dexmedetomidine group than in the propofol group [32] . During robot-assisted laparoscopic prostatectomy, the HR of dexmedetomidine group was significantly lower than that of saline group Chin Med Sci J ISSN 1001-9294 CN 11-2752/R DOI: 10.24920/004088 [33] . Among conscious patients undergoing carotid endarterectomy, the intraoperative HR, SBP, and DBP in dexmedetomidine group were lower than those in metoprolol and labetolol groups [34] .…”

Effect of pneumoperitoneum and Trendelenburg position on internal carotid artery blood flow measured by ultrasound during robotic prostatectomy

“…Surgical procedures in this specific condition might have consequences including neurologic deterioration in patients with cerebrovascular disease (Casati et al, 2007; Gainsburg, 2012). Previous studies reported that pneumoperitoneum and the ST position caused a significant reduction in cerebral oxygen saturation in elderly patients (Casati et al, 2007) as well as increased ICP during robotic prostatectomy (Jun et al, 2018; Yu et al, 2018, 2019). These unfavourable changes were associated with cerebral ischaemia, postoperative cognitive dysfunction, postoperative delirium, and longer hospital stay (Casati et al, 2005; Green, 2007).…”

Prognostic Role of Optic Nerve Sheath Diameter for Neurological Outcomes in Post-Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

“…A typical optic nerve sheath is less than 5 mm and is considered to be a good neurological outcome for post-CA patients. Future studies should establish the best cutoff values for ONSD that correlate with poor neurological outcome and that can be standardized for diverse subgroups categorized by age, temperature treatment, and condition [ 24 ].…”