Effect of Mannitol on Ultrasonographically Measured Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure During Robot-Assisted Laparoscopic Prostatectomy with Pneumoperitoneum and the Trendelenburg Position

Jun, In-Jung; Kim, Myong; Park, Se-Ung; Hwang, Jai‐Hyun; Hong, Jun Hyuk; Kim, Young‐Kug

doi:10.1089/end.2017.0828

Cited by 20 publications

(10 citation statements)

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“…Similar to the results of a previous study, our results confirmed that ONSD increases in the Trendelenburg position with pneumoperitoneum [ 5 , 23 , 24 ]. The increase in ONSD during surgery means sustained elevation of ICP in the corresponding period.…”

Section: Discussionsupporting

confidence: 92%

Effects of Increased Optic Nerve Sheath Diameter on Inadequate Emergence from Anesthesia in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study

et al. 2021

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(1) Background: Robot-assisted laparoscopic prostatectomy (RALP) is preferred over open prostatectomy because it offers superior surgical outcomes and better postoperative recovery. The steep Trendelenburg position and pneumoperitoneum required in Robot-assisted laparoscopic prostatectomy, however, increase intracranial pressure (ICP). The present study aimed to evaluate the effects of elevated ICP on the quality of emergence from anesthesia. (2) Methods: Sixty-seven patients undergoing RALP were enrolled. We measured optic nerve sheath diameter at four timepoints during surgery. Primary outcome was inadequate emergence in the operating room (OR). Secondary outcomes were postoperative neurologic deficits of dizziness, headache, delirium, cognitive dysfunction, and postoperative nausea and vomiting (PONV). (3) Results: A total of 69 patients were screened for eligibility and 67 patients completed the study and were included in the final analysis. After establishing pneumoperitoneum with the Trendelenburg position, ONSD increased compared to baseline by 11.4%. Of the 67 patients, 36 patients showed an increase of 10% or more in optic nerve sheath diameter (ONSD). Patients with ΔONSD ≥ 10% experienced more inadequate emergence in the OR than those with ΔONSD < 10% (47.2% vs. 12.9%, p = 0.003). However, other variables related to the quality of emergence from anesthesia did not different significantly between groups. Similarly, neurologic deficits, and PONV during postoperative day 3 showed no significant differences. (4) Conclusions: ICP elevation detected by ultrasonographic ONSD measurement was associated with a transient, inadequate emergence from anesthesia.

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Section: Discussionsupporting

confidence: 92%

Effects of Increased Optic Nerve Sheath Diameter on Inadequate Emergence from Anesthesia in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study

et al. 2021

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“…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).…”

Section: Discussionmentioning

confidence: 96%

“…Robotic prostatectomy was conducted on a da Vinci robotic system using the standard technique at our centre (Jun et al, 2018; Yu et al, 2021). The pneumoperitoneum was maintained at intraabdominal pressure of 15 mmHg with carbon dioxide gas.…”

Section: Methodsmentioning

confidence: 99%

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

Park

Hong

et al. 2022

Clin Physio Funct Imaging

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Introduction Robotic prostatectomy requires pneumoperitoneum and a steep Trendelenburg position; however, this condition may compromise cerebral blood flow. Here, we evaluated the effect of pneumoperitoneum and the steep Trendelenburg position on internal carotid artery (ICA) blood flow measured by Doppler ultrasound during robotic prostatectomy. Methods Patients who underwent robotic prostatectomy were prospectively recruited. The ICA blood flow was measured at the following five time‐points: with the patient awake and in the supine position (Ta), 10 min after anaesthetic induction in the supine position (T1), 10 (T2) and 30 (T3) min after pneumoperitoneum in the steep Trendelenburg position, and at the end of surgery in the supine position after desufflation of the pneumoperitoneum (T4). Hemodynamic and cerebrovascular variables were measured at each time‐point. Results A total of 28 patients were evaluated. The ICA blood flows were significantly lower at T2 and T3 than at T1 (162.3 ± 44.7 [T2] vs. 188.0 ± 49.6 ml/min [T1]; p = .002, 163.1 ± 39.9 [T3] vs. 188.0 ± 49.6 ml/min [T1]; p = .009). The ICA blood flow also differed significantly between Ta and T1 (236.8 ± 58.3 vs. 188.0 ± 49.6 ml/min; p < .001). Heart rates, cardiac indexes, peak systolic velocity, and end‐diastolic velocity were significantly lower at T2 and T3 than at T1. However, ICA diameter, mean blood pressure, and end‐tidal carbon dioxide partial pressure did not differ significantly at all time‐points. Conclusion Pneumoperitoneum and the steep Trendelenburg position caused decreased ICA blood flow, suggesting that they should be carefully performed during robotic prostatectomy, especially in patients at risk of postoperative cerebrovascular accident.

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“…Previous studies have shown that ONSD, a non-invasive surrogate for ICP, is significantly increased in patients undergoing RALP. [15,18] Therefore, active interventions to attenuate the ICP increase may be needed for patients with prostate cancer who undergo RALP under pneumoperitoneum in the steep Trendelenburg position.…”

Section: Discussionmentioning

confidence: 99%

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

Yu¹,

Park²,

Kim³

et al. 2019

Medicine

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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.

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Effect of Mannitol on Ultrasonographically Measured Optic Nerve Sheath Diameter as a Surrogate for Intracranial Pressure During Robot-Assisted Laparoscopic Prostatectomy with Pneumoperitoneum and the Trendelenburg Position

Abstract: Mannitol decreases the ONSD in patients undergoing RALP with CO pneumoperitoneum and the steep Trendelenburg position. This result provides useful information on the beneficial effects of mannitol administration on prostate cancer patients who may develop increased ICP during RALP.

Cited by 20 publications

References 34 publications

Effects of Increased Optic Nerve Sheath Diameter on Inadequate Emergence from Anesthesia in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study

Effects of Increased Optic Nerve Sheath Diameter on Inadequate Emergence from Anesthesia in Patients Undergoing Robot-Assisted Laparoscopic Prostatectomy: A Prospective Observational Study

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

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

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