Increase in Intracranial Pressure During Carbon Dioxide Pneumoperitoneum with Steep Trendelenburg Positioning Proven by Ultrasonographic Measurement of Optic Nerve Sheath Diameter
Abstract Purpose: The purpose of this study was to assess the extent of the increased intracranial pressure (ICP) resulting from CO2 pneumoperitoneum and steep Trendelenburg positioning using ultrasonographic measurement of optic nerve sheath diameter (ONSD) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Patients and Methods: Twenty patients who underwent elective RALRP were enrolled in this study. ONSD and regional cerebral oxygen saturation (rSO2) were investigated noninvasively using ocular ultrasonography and near-infrared spectroscopy before anesthesia (T0), 10 minutes after anesthesia induction in the supine position (T1), 10 and 30 minutes after CO2 pneumoperitoneum with 30-degree Trendelenburg positioning (T2 and T3), and after returning to supine position without CO2 pneumoperitoneum at the conclusion of the RALRP (T4). Results: The mean values of ONSD at all time points (T1, T2, T3, and T4) after general anesthesia significantly increased compared with that before general anesthesia (T0). During CO2 pneumoperitoneum with 30-degree Trendelenburg positioning (T2, T3), a significant increase of 12.5% in ONSD was observed in comparison with ONSD after anesthesia induction in the supine position without CO2 pneumoperitoneum (T1). Three patients had an ONSD value equivalent to an ICP above 20 mm Hg, and these patients did not experience a decrease of rSO2 or any neurologic complications. Conclusions: In patients undergoing RALRP, the increase of 12.5% in ONSD during CO2 pneumoperitoneum with steep Trendelenburg positioning was observed and thus the increase of ICP corresponding to this change of ONSD could be predicted. In 15% of the enrolled patients, ONSD increased by values equivalent to an ICP above 20 mm Hg without a deterioration of rSO2 or any neurologic complications.
Pharmacology, Toxicology and Pharmaceutical Science
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Immunology and Microbiology
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Other
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Attention Score in Context
Attention Score in Context
This research output has an Altmetric Attention Score of 3. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 July 2014.
All research outputs
#14,474,744
of 25,377,790 outputs
Outputs from Journal of Endourology
#1,202
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Outputs of similar age
#114,257
of 235,870 outputs
Outputs of similar age from Journal of Endourology
#16
of 31 outputs
Altmetric has tracked 25,377,790 research outputs across all sources so far. This one is in the 42nd percentile – i.e., 42% of other outputs scored the same or lower than it.
So far Altmetric has tracked 2,042 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 5.2. This one is in the 39th percentile – i.e., 39% of its peers scored the same or lower than it.
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We're also able to compare this research output to 31 others from the same source and published within six weeks on either side of this one. This one is in the 45th percentile – i.e., 45% of its contemporaries scored the same or lower than it.
