Ovarian Cancer Clinical Trial
Official title:
Comparison of Optic Nerve Sheath Diameter According to Position During Laparoscopy
Increase of intracerebral pressure (ICP) during laparoscopic surgery has known to be associated with positional changes. Optic nerve sheath diameter (ONSD) has correlation with ICP and ultrasonographic measurement of optic nerve sheath diameter (ONSD) is known to be a noninvasive and rapidly applicable technique for evaluating ICP. The aim of this study is to investigate the change of ONSD according to the positional change during laparoscopic surgery.
1. Purpose There can be many physiologic changes during laparoscopic surgery. Increase of
intracerebral pressure (ICP) is one of them, which has known to be associated with
arterial concentration of carbon dioxide or positional changes. Changes of ICP can be
measured directly by invasive method. However, optic nerve sheath diameter (ONSD) has
correlation with ICP and ultrasonographic measurement of optic nerve sheath diameter
(ONSD) is known to be a noninvasive and rapidly applicable technique for evaluating
ICP. The aim of this study is to investigate the change of ONSD according to the
positional change during laparoscopic surgery.
2. Hypothesis Changes of ONSD will be shown according to the positional change during
laparoscopic surgery, and these can reflect the changes of ICP.
3. Objectives Female patients who are scheduled to undergo laparoscopic surgery, American
society of anesthesiologist class (ASA) I-II, aged between 19 to 65 years, are
allocated into 2 groups.
- Group 1: Laparoscopic gynecological surgery, (Trendelenburg position)
- Group 2: Laparoscopic cholecystectomy, (Reverse trendelenburg position)
4. Methods Patients are premedicated with midazolam 0.5 mg/kg before transported to the
operating room. Once in the operating room, patients were monitored with
electrocardiography, non invasive blood pressure, pulse oximetry (Datex-Ohmeda S/5,
Planar Systems, Inc., Beaverton, OR, USA) and BIS (Aspect 2000, Aspect Medical Systems,
Inc., Newton, MA, USA).
Anesthesia are induced with propofol (2mg/kg) and followed by administering rocuronium
0.6 mg/kg. After tracheal intubation, the lungs of the patients were then ventilated
with oxygen in air (1:2) using a tidal volume of 8-10 mL/kg and a respiratory rate of
10-12/min, and the ventilation rate was adjusted to maintain the end-tidal carbon
dioxide partial pressure between 35 and 40 mmHg and peak inspiratory pressure below 30
cmH2O. Anesthesia is maintained with desflurane in addition to the continuous infusion
of remifentanil. Radial arterial cannulation is done for invasive arterial blood
pressure monitoring.
After induction of anesthesia, when stabilization of cardiovascular status is achieved,
optic nerve sheath diameter (ONSD) is measured by ultrasonographic measurement.
Patients were placed in the supine position with their eyes closed, and a thick gel
layer was applied to the closed upper eyelid. The 7.5-MHz linear probe was placed on
the gel without excessive pressure and adjusted to the proper angle for displaying the
entry of the optic nerve into the globe. The intensity of the ultrasound was adjusted
to display optimal contrast between the retrobulbar echogenic fat tissue and the
vertical hypoechoic band. An ultrasound beam was focused on the retrobulbar area (4 cm
deep) using the lowest possible acoustic power that could measure ONSD. The ONSD was
measured 3 mm behind the optic disc. Measurements were performed in the transverse and
sagittal planes of both eyes, and the final ONSD value was calculated by averaging 4
measured values.
ONSD was measured at 7 serial time points during surgery:
1. Preinduction (prior to the induction of anesthesia in the operating room)
2. 5 minutes after induction of anesthesia
3. 5 minutes after introducing pneumoperitoneum
4. 5 minutes after positional change
5. 15 minutes after positional change
6. 30 minutes after positional change
7. 5 minutes after discontinuing pneumoperitoneum Arterial blood gas analysis is
performed to evaluate the arterial carbon dioxide concentration (PaCO2) level at
each time point.
5. Statistical Analysis All data are expressed as numbers (%) or mean ± standard
deviation. Repeated measures ANOVA will be performed to compare the parameters at
specific time points during surgery.
;
Allocation: Non-Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Diagnostic
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