Purpose:

Evaluation of optic sheath diameter as a guide for raised intracranial pressure in patients undergoing prolonged laproscopic/ robotic surgeries in steep trendelenburg position.

Background:

Steep trendelenburg position of upto 40 degrees may be required for robotic and laproscopic pelvic surgeries. It may cause alteration in cerebral homeostasis and impaired cerebral auto–regulation and raised ICP. ONSD assessment can be used to assess changes in ICP.

Methods:

In a prospective, observational, non–interventional and open study, ONSD of 30 patients undergoing robotic/laproscopic pelvic surgeries in steep trendelenburg position lasting more than 4 hours (Group I) was compared with 30 patients undergoing donor hepatectomy in supine position without trendelenburg position (Group II). Intra–operative haemodynamic parameters, ONSD after induction of anesthesia, 4 hours after induction and after completion of surgery was measured and compared between two groups.

Results:

A small but significant increase in ONSD in prolonged steep trendelenburg position with pneumoperitoneum was observed (p value < 0.001 ). The magnitude of increase was not enough to be labeled as intracranial hypertension. ONSD is a good non invasive modality for assessment of raised ICP secondary to cerebral oedema. It may be used to initiate timely interventions.

Conclusion:

ONSD may serve as a guide for initiating timely interventions to keep ICR within normal range