Propofol attenuates the increase of sonographic optic nerve sheath diameter during robot-assisted laparoscopic prostatectomy: a randomized clinical trial

Abstract

BackgroundRobot-assisted laparoscopic prostatectomy (RALP) requires pneumoperitoneum and the Trendelenburg position to optimize surgical exposure, which can increase intracranial pressure (ICP). Anesthetic agents also influence ICP. We compared the effects of propofol and sevoflurane on sonographic optic nerve sheath diameter (ONSD) as a surrogate for ICP in prostate cancer patients who underwent RALP.MethodsThirty-six patients were randomly allocated to groups receiving propofol (propofol group, n = 18) or sevoflurane (sevoflurane group, n = 18) anesthesia. The ONSD was measured 10 min after induction of anesthesia in the supine position (T1); 5 min (T2), 30 min (T3), and 60 min (T4) after establishing pneumoperitoneum and the Trendelenburg position; and at the end of surgery after desufflation in the supine position (T5). Respiratory and hemodynamic variables were also evaluated.ResultsThe ONSD was significantly different between the propofol group and the sevoflurane group at T4 (5.27 ± 0.35 mm vs. 5.57 ± 0.28 mm, P = 0.007), but not at other time points. The ONSDs at T2, T3, T4, and T5 were significantly greater than at T1 in both groups (all P < 0.001). Arterial carbon dioxide partial pressure, arterial oxygen partial pressure, peak airway pressure, plateau airway pressure, systolic blood pressure, pulse pressure variation, body temperature and regional cerebral oxygen saturation, except heart rate, were not significantly different between the two groups.ConclusionsThe ONSD was significantly lower during propofol anesthesia than during sevoflurane anesthesia 60 min after pneumoperitoneum and the Trendelenburg position, suggesting that propofol anesthesia may help minimize ICP changes in robotic prostatectomy patients.Trial registrationClinicaltrials.gov identifier: NCT03271502. Registered August 31, 2017.

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

“…Contrary to our findings, Yu et al [ 24 ] and Choi et al [ 25 ] showed that the ONSD was significantly lower during propofol anesthesia than during inhalation anesthesia after CO 2 pneumoperitoneum induction and Trendelenburg positioning in RALRP. Yu et al [ 24 ] reported that there are no significant differences in the ONSD between the two groups until 30 min after CO 2 pneumoperitoneum induction and Trendelenburg positioning, corresponding to T3 of our study. In contrast to our study, their mean anesthesia time was 189.2 ± 19.8 min, which is twice as long as ours, and the average age of their patients was 65 years, which is greater than that of ours (45 years).…”

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

“…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.…”

“…The sample size was calculated based on our experience and previous study [15] . The mean ± standard deviation of ONSD at 60 minutes after establishment of carbon dioxide pneumoperitoneum in the steep Trendelenburg position under sevoflurane anesthesia was 5.6 ± 0.43 mm.…”

The effect of laryngoscope types on hemodynamic response and optic nerve sheath diameter

“…Transocular ultrasound optic nerve sheath diameter (ONSD) measurement is the most prominent of these methods. [26][27][28][29][30][31][32][33][34][35][36] When ICP increases, the sheath diameter is enlarged, and this change in diameter allows ICP to be evaluated indirectly by ultrasound via the optic nerve sheath. 28 This study aimed to investigate the effects of 3 different laryngoscopes (the McCoy, and Macintosh laryngoscopes and the C-MAC® video-laryngoscope) on laryngoscopy, ONSD, intubation and hemodynamic response in patients with normal airways.…”

“…[26][27][28][29][30][31][32][33] The intraoperative use of ONSD has gained popularity, and many studies have evaluated ONSD in anesthesia applications. [26][27][28][29][30][31][32][33][34] In a meta-analysis of ONSD in laparoscopic surgeries, it was found that the increase in ICP at the early and late stages of pneumoperitoneum could be evaluated by ONSD measurement. 26 In a study performed in robotic prostate surgeries, ONSD increased in a time-dependent manner following baseline measurement after pneumoperitoneum and a 45 degrees Trendelenburg position.…”