Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy.
<h4>Background</h4>During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the...
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Public Library of Science (PLoS)
2014-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0111916&type=printable |
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| author | Philip Verdonck Alain F Kalmar Koen Suy Thomas Geeraerts Marcel Vercauteren Alex Mottrie Andre M De Wolf Jan F A Hendrickx |
| author_facet | Philip Verdonck Alain F Kalmar Koen Suy Thomas Geeraerts Marcel Vercauteren Alex Mottrie Andre M De Wolf Jan F A Hendrickx |
| author_sort | Philip Verdonck |
| collection | DOAJ |
| description | <h4>Background</h4>During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD) measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF) shifts becomes exhausted.<h4>Methods</h4>After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA I-II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP) was calculated as the mean arterial (MAP) minus central venous pressure (CVP).<h4>Results</h4>The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times.<h4>Conclusion</h4>Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small. |
| format | Article |
| id | doaj-art-807c1f43854c4e2eaafedf87f8c85b51 |
| institution | Kabale University |
| issn | 1932-6203 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-807c1f43854c4e2eaafedf87f8c85b512025-01-17T05:32:09ZengPublic Library of Science (PLoS)PLoS ONE1932-62032014-01-01911e11191610.1371/journal.pone.0111916Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy.Philip VerdonckAlain F KalmarKoen SuyThomas GeeraertsMarcel VercauterenAlex MottrieAndre M De WolfJan F A Hendrickx<h4>Background</h4>During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath diameter (ONSD) measurement, may warn us that the mechanism of protective cerebrospinal fluid (CSF) shifts becomes exhausted.<h4>Methods</h4>After obtaining IRB approval and written informed consent, ONSD was measured by ocular ultrasound in 20 ASA I-II patients at various stages of the RALRP procedure: baseline awake, after induction, after applying the CO2PP, during head-down position, after resuming the supine position, in the postoperative anaesthesia care unit, and on day one postoperatively. Cerebral perfusion pressure (CPP) was calculated as the mean arterial (MAP) minus central venous pressure (CVP).<h4>Results</h4>The ONSD did not change during head-down position, although the CVP increased from 4.2(2.5) mm Hg to 27.6(3.8) mm Hg. The CPP was decreased 70 min after assuming the head-down position until 15 min after resuming the supine position, but remained above 60 mm Hg at all times.<h4>Conclusion</h4>Even though ICP has been documented to increase during CO2PP and head-down positioning, we did not find any changes in ONSD during head-down position. These results indicate that intracranial blood volume does not increase up to a point that CSF migration as a compensation mechanism becomes exhausted, suggesting any increases in ICP are likely to be small.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0111916&type=printable |
| spellingShingle | Philip Verdonck Alain F Kalmar Koen Suy Thomas Geeraerts Marcel Vercauteren Alex Mottrie Andre M De Wolf Jan F A Hendrickx Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. PLoS ONE |
| title | Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. |
| title_full | Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. |
| title_fullStr | Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. |
| title_full_unstemmed | Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. |
| title_short | Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. |
| title_sort | optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0111916&type=printable |
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