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Increased intracranial pressure (IICP) is a common problem in traumatic brain injuries and many medical diseases. Early recognition of IICP can save lives. Several invasive and non-invasive methods have been described for IICP diagnosis. In recent years, ultrasonographic measurement of optic nerve sheath diameter (ONSD) has become a popular method due to its high sensitivity and specificity for IICP estimation. Studies have shown that ONSD's ultrasonographic measurement correlates with the IICP and can detect intracranial hypertension. The ONSD measurement has advantages such as being easily applied by the clinician at the bedside, being non-invasive, providing immediate results, reproducibility and low cost. It is known that artificial carbon dioxide pneumoperitoneum created in laparoscopic surgeries increases intracranial pressure.However, it is not easy to estimate the degree of changes in ICP during laparoscopic surgery under general anesthesia. In the literature, there are many studies on the sonographic measurement of optic nerve sheath diameter to evaluate the effects of trendelenburg position on intracranial pressure with the use of different anesthetic drugs in laparoscopic surgeries. In addition, there are studies reporting that deep neuromuscular blockade in laparoscopic surgeries increases surgical vision and decreases analgesic requirement in postoperative period. The relationship between neuromuscular block level and intracranial pressure is not clear. From this point of view, the investigators would like to evaluate the effect of moderate and deep neuromuscular block level on intracranial pressure by sonographic measurement of optic nerve sheath diameter in laparoscopic cholecystectomy operations performed with standard pressure artificial carbon dioxide pneumoperitoneum.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Deep neuromuscular block | Other | Patients undergoing deep neuromuscular blockade with rocuronium (TOF -- PTC 1-5) |
|
| Moderate neuromuscular block | Active Comparator | Patients undergoing moderate neuromuscular blockade with rocuronium (TOF 1-3) |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Ultrasonographic measurement of optic nerve sheath diameter | Diagnostic Test | Optic nerve sheath diameter will be measured at both neuromuscular blocks level. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Optic nerve sheath diameter | Sonographic optic nerve sheath measurements will be made 5 times, preoperatively, 5 minutes after endotracheal intubation, 5 minutes after pneumoperitoneum, 5 minutes after pneumoperitoneum is terminated and after extubation | During surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Headache | The severity of the headache in the first 24 hours postoperatively(0=never, 1= rarely, 2= sometimes, 3= very often, 4= always) | 24 hours |
| Postoperative nausea and vomiting score | Nausea-vomiting were assessed with postoperative nausea and vomiting scale (PONV) (0=no PONV, 1= mild nausea, 2= severe nausea or vomiting once, 3= vomiting more than once) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Serdar Yeşiltaş, Instructor | Contact | +905423632630 | syesiltas@bezmialem.edu.tr |
| Name | Affiliation | Role |
|---|---|---|
| Serdar Yeşiltaş, Instructor | BEZMİALEM VAKIF UNIVERSITY | Principal Investigator |
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Patients will be randomly divided into 2 groups. In the first group (Group 1), patients undergoing intraabdominal insufflation pressure 12 mmHg and deep neuromuscular block (TOF -- PTC 1-5), in the second group (Group 2) patients undergoing intraabdominal insufflation pressure 12 mmHg and moderate neuromuscular block (TOF 1-3) It would be classified.
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The participants were blinded to group allocation, as the measurements were performed after induction of general anesthesia. The investigator measuring the optic nerve sheath diameter was blinded to the group assignment.
| Deep neuromuscular block | Procedure | Deep neuromuscular block will be obtained via appropriate dose of rocuronium. |
|
| Moderate neuromuscular block | Procedure | Moderate neuromuscular block will be obtained via appropriate dose of rocuronium. |
|
| 24 hours |
| Patient satisfaction score | Patient satisfaction measured using a NRS 1 to 10 (1 = unsatisfied; 10 =very satisfied) | 24 hours |
| ID | Term |
|---|---|
| D019586 | Intracranial Hypertension |
| ID | Term |
|---|---|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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