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The aim of this study is to investigate the effects of low and normal intraperitoneal pressures on intraoperative optic nerve sheath diameter in laparoscopic gyneco-oncologic surgeries.
Gynecological surgeries are minimally invasive procedures. The establishment of pneumoperitoneum, special patient positioning, and surgical stimulation can induce a stress response in patients. Carbon dioxide (COâ‚‚) pneumoperitoneum and the Trendelenburg position lead to increases in intra-abdominal, intrathoracic, and airway pressures, which in turn may directly or indirectly cause elevations in intracranial and intraocular pressures.
During the perioperative period, the optic nerve sheath diameter (ONSD), measured ultrasonographically, is used as a reliable method to estimate intracranial pressure (ICP). Monitoring ICP under anesthesia may help prevent neurological complications such as neurological deterioration and optic neuropathy. Furthermore, studies have demonstrated ICP changes in robotic and laparoscopic gynecologic surgeries through ultrasonographic measurement of ONSD.
Traditionally, laparoscopic abdominal surgeries are performed using intraperitoneal pressures ranging between 10 and 18 mmHg. Lower intra-abdominal pressures have been associated with reduced postoperative pain, improved pulmonary parameters, and a decreased risk of gas embolism. However, the data on these outcomes remain limited.
In this study, we aimed to investigate the effect of pressures above and below 12 mmHg on the optic nerve sheath diameter-and consequently on intracranial pressure-in patients undergoing laparoscopic gynecologic surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Low Pressure Group | Experimental | In laparoscopic gyneco-oncological surgeries, low pressure group received below 12 mmHg intraperitoneal pressure. |
|
| Normal Pressure Group | Experimental | In laparoscopic gyneco-oncological surgeries, normal pressure group received 12 and abowe 12 mmHg intraperitoneal pressure. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Low pressure group | Other | In laparoscopic gyneco-oncological surgeries, low pressure group will receive below 12 mmHg intraperitoneal pressure. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Measurement of optic nerve sheath diameter (ONSD) | ONSD will be measured in the supine position by ulrasonographic measurement.After obtaining optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band, the ONSD will be measured 3 mm behind the optic disc using an electronic caliper. The final ONSD value was calculated by averaging 4 measured values: measured values of transverse and sagittal plane of both eyes. | 30 minutes after introducing pneumoperitoneum and position change |
| Measure | Description | Time Frame |
|---|---|---|
| Measurement of optic nerve sheath diameter (ONSD) | ONSD will be measured by ulrasonographic measurement.After obtaining optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band, the ONSD will be measured 3 mm behind the optic disc using an electronic caliper. The final ONSD value was calculated by averaging 4 measured values: measured values of transverse and sagittal plane of both eyes. |
| Measure | Description | Time Frame |
|---|---|---|
| numerical rating scale (NRS) at rest | Recording the patient's pain at rest on the Numerical Rating Scale (NRS) by asking the patient | popstoperative 1. hour |
| numerical rating scale (NRS) at rest | Recording the patient's pain at rest on the Numerical Rating Scale (NRS) by asking the patient |
Inclusion Criteria:
Exclusion Criteria:
The study will be conducted in gyneco-oncological surgeries. The patient group will consist exclusively of female patients.
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Zeynep Koç | Contact | 05345958843 | zeynepyilmazkoc@hotmail.com |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Zeynep Koç | Yenimahalle | Ankara | Turkey (Türkiye) |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 33329767 | Background | Lee YY, Lee H, Park HS, Kim WJ, Baik HJ, Kim DY. Optic nerve sheath diameter changes during gynecologic surgery in the Trendelenburg position: comparison of propofol-based total intravenous anesthesia and sevoflurane anesthesia. Anesth Pain Med (Seoul). 2019 Oct 31;14(4):393-400. doi: 10.17085/apm.2019.14.4.393. | |
| 33504329 | Background |
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The optic nerve sheath diameter measurements will be shared with other researchers in the later stages of the study.
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In laparoscopic gyneco-oncological surgeries, one group will receive low intraperitoneal pressure, while the other group will receive standart intraperitoneal pressure.
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The investigator will be blinded to whether low or intraperitoneal pressure is applied to the patients.
| Normal pressure group | Other | In laparoscopic gyneco-oncological surgeries, normal pressure group will receive 12 and abowe 12 mmHg intraperitoneal pressure. |
|
| The baseline ONSD measurement will be performed 5 minutes after endotracheal intubation |
| Measurement of optic nerve sheath diameter (ONSD) | ONSD will be measured in the supine position by ulrasonographic measurement.After obtaining optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band, the ONSD will be measured 3 mm behind the optic disc using an electronic caliper. The final ONSD value was calculated by averaging 4 measured values: measured values of transverse and sagittal plane of both eyes. | 5 minutes after introducing pneumoperitoneum and position change |
| Measurement of optic nerve sheath diameter (ONSD) | ONSD will be measured by ulrasonographic measurement.After obtaining optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band, the ONSD will be measured 3 mm behind the optic disc using an electronic caliper. The final ONSD value was calculated by averaging 4 measured values: measured values of transverse and sagittal plane of both eyes. | 60 minutes after introducing pneumoperitoneum and position change |
| Measurement of optic nerve sheath diameter (ONSD) | ONSD will be measured by ulrasonographic measurement.After obtaining optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band, the ONSD will be measured 3 mm behind the optic disc using an electronic caliper. The final ONSD value was calculated by averaging 4 measured values: measured values of transverse and sagittal plane of both eyes. | 90 minutes after introducing pneumoperitoneum and position change |
| Measurement of optic nerve sheath diameter (ONSD) | ONSD will be measured in the supine position by ulrasonographic measurement.After obtaining optimal contrast between the retrobulbar echogenic fat tissue and the vertical hypoechoic band, the ONSD will be measured 3 mm behind the optic disc using an electronic caliper. The final ONSD value was calculated by averaging 4 measured values: measured values of transverse and sagittal plane of both eyes. | The ONSD measurement will be performed 5 minutes after the pneumoperitoneum is released and the Trendelenburg position is corrected. |
| popstoperative 8. hours |
| postoperative nosia and vomiting (PONV) | Recording the presence or absence of nausea and vomiting in the patient within the first 24 hours postoperatively | popstoperative 1. hour |
| postoperative nosia and vomiting (PONV) | Recording the presence or absence of nausea and vomiting in the patient within the first 24 hours postoperatively | popstoperative 8. hours |
| headache | The presence or absence of headache will be assessed and documented. | popstoperative 8. hours |
| Geng W, Chen C, Sun X, Huang S. Effects of sevoflurane and propofol on the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery: a randomized controlled clinical studies. BMC Anesthesiol. 2021 Jan 27;21(1):30. doi: 10.1186/s12871-021-01243-7. |
| 26257848 | Background | Kim SH, Kim HJ, Jung KT. Position does not affect the optic nerve sheath diameter during laparoscopy. Korean J Anesthesiol. 2015 Aug;68(4):358-63. doi: 10.4097/kjae.2015.68.4.358. Epub 2015 Jul 28. |
| ID | Term |
|---|---|
| D019586 | Intracranial Hypertension |
| D015746 | Abdominal Pain |
| D006261 | Headache |
| ID | Term |
|---|---|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D010146 | Pain |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D012817 | Signs and Symptoms, Digestive |
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