Total Laparoskopik Histerektomi Yapılan Hastalarda İntraabdominal Basıncın Optik Sinir Kılıfı Çapına Etkisinin Değerlendirilmesi

Abstract

BAYRAMOV T. Evaluation of Effect of Intra Abdominal Pressure to Optic Nerve Sheath Diameter on Total Laparoscopic Hysterectomy Hacettepe University School of Medicine-Department of Anesthesiology and Reanimation, Specialty Thesis, Ankara, 2017 An adequate surgical exposure requires the application of a CO2 pneumoperitoneum (PP) and often a concomitant steep head-down position (up to 30-35°; Trendelenburg position; TP). Pneumoperitoneum and the consequent increased intraabdominal pressure can have many systemic physiological consequences, including decreased venous return, hypercapnia, and respiratory acidosis as a result of absorption of CO2 across the peritoneal surface. There is growing evidence that demonstrates a positive correlation between intra-abdominal pressure and ICP. Optic nerve sheath diameter(ONSD) can be detected by ultrasonographic evaluation. The aim of this study is to evaluated the changes in ICP and correlate those by means of ONSD in a controlled model of acute elevation of IAP and in TP in 59 female between 22-74 years , ASA I-II-III patients undergoing total laparoscopic hysterectomy procedure. Patients undergoing Total Laparoscopic Hysterectomy (TLH) procedure between April and November 2017 were included. Patients were excluded if they were under 19 years of age or had past medical history of ocular pathology or surgery or history of elevated intracranial pressure (ICP). Data were collected prospectively on the age, American Society of Anesthesiologists Physical Status Classification System(ASA class), body mass index (BMI), optic nerve sheath diameter (ONSD), mean arterial blood pressure(MAP), end tidal CO2(EtCO2), partial pressure of CO2 in arterial blood (pCO2) from patients who signed informed consents to participate in the study. Participants had noninvasive ultrasound measurement(T) of their ONSD performed 4 times, each time by three anesthesiologists who were trained on this procedure: T0 - immediately after induction of general anesthesia in hemodynamically stable patient in the horizontal position for baseline; T1- 3 min. after pneumoperitoneum at 20 mm Hg on horizontal position; T2- 3 min. after pnuemoperitoneum at 15 mm Hg on Trendelenburg position (TP);T3 - After deflation of pneumoperitoneum on horizontal position. There was no significant difference in MAPs of patients in all time periods (p> 0.05). PaCO2 and EtCO2 values were significantly increased by increased intraabdominal pressure and TP compared by baseline (p <0.05); Basal value (T0) ONSD value measured as 5.63 ± 0.53 mm; After 20 mm Hg pneumoperitoneum, there was a statistically significant increase in the horizontal position (T1) (5,97 ± 0,49 mm) and 15 mm Hg pneumoperitoneum + TP (T2) (5,95 ± 0,57 mm) ) (p<0.05). At the end of the operation (T3) was determined that the value of ONSD (5,72 ± 0,47 mm) was approaching the baseline value again (p＜0.05). There was no correlation between ONSD and MAP, EtCO2 and PaCO2 values (p> 0.05). In laparoscopic procedures; we showed that both the position and the increased intraabdominal pressure increase ONSD and at the end of the operation reached the basal values. We think that laparoscopic interventions or during clinical follow-up ultrasonographic measurement of ONSD can be used especially in patients at risk for intracranial hypertension. Keywords: Optic Nerve Sheath Diameter, Intraabdominal Pressure, Intracranial Pressure, Total Laparoscopic Hysterectomy