Changes in Optic Nerve Sheath Diameter in Response to Various Levels of End-Tidal Carbon Dioxide in Healthy Patients under General Anesthesia

Indu Kapoor; Ankur Khandelwal; Charu Mahajan; Hemanshu Prabhakar; Parmod Kumar Bithal

doi:10.1055/s-0038-1654749

Journal of Neuroanaesthesiology and Critical Care, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(02): 94-97
DOI: 10.1055/s-0038-1654749

Original Article

Indian Society of Neuroanaesthesiology and Critical Care

Changes in Optic Nerve Sheath Diameter in Response to Various Levels of End-Tidal Carbon Dioxide in Healthy Patients under General Anesthesia

Indu Kapoor

¹Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

,

Ankur Khandelwal

¹Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

,

Charu Mahajan

¹Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

,

Hemanshu Prabhakar

¹Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

,

Parmod Kumar Bithal

¹Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India

› Institutsangaben

Abstract

Background Intracranial pressure (ICP) monitoring is an essential component in management of traumatic brain-injured (TBI) patients. While invasive techniques are associated with many complications, noninvasive nature of ultrasonographic measurement of optic nerve sheath diameter (ONSD) is now becoming popular. Carbon dioxide (CO₂) alters the ICP by changing the size of cerebral vasculature. We aimed to assess the effect of (hypercarbia and hypocarbia) different levels of end-tidal carbon dioxide (EtCO₂) on ONSD.

Methods Thirty adult patients aged between 18 and 65 years, undergoing brachial plexus injury surgery under general anesthesia, were enrolled. Following standard anesthetic protocol, ONSD was measured at different time points of EtCO₂. ONSD was measured at EtCO₂ of 40 and then 30 mm Hg to assess change in ONSD due to hypocarbia (T_hypocarbia). Similarly, ONSD was measured at EtCO₂ of 50 mm Hg to assess change in ONSD due to hypercarbia (T_hypercarbia). The mean of three ONSD values at each time point was taken as the final value. The generalized estimating equation (GEE) was used to analyze correlation between different levels of EtCO₂ and ONSD.

Results The calculated 95% confidence interval (CI) for the difference of two measures (T_hypocarbia, EtCO₂ 40 and 30 mm Hg) on ONSD was −0.056 to −0.036, and the calculated CI for the difference of other two measures (T_hypercarbia, EtCO₂ 40 and 50 mm Hg) on ONSD was 0.044 to 0.077, and thus were observed to be significant.

Conclusions ONSD changes significantly in response to different EtCO₂ levels in healthy non-neurosurgical patients under general anesthesia.

Keywords

optic nerve sheath diameter - end-tidal carbon dioxide - intracranial pressure - hypocapnia - hypercapnia

Volltext

Referenzen

References
1 Kim DR, Yang S-H, Sung JH, Lee SW, Son BC. Significance of intracranial pressure monitoring after early decompressive craniectomy in patients with severe traumatic brain injury. J Korean Neurosurg Soc 2014; 55 (01) 26-31
2 Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007; 49 (04) 508-514
3 Shirodkar CG, Munta K, Rao SM, Mahesh MU. Correlation of measurement of optic nerve sheath diameter using ultrasound with magnetic resonance imaging. Indian J Crit Care Med 2015; 19 (08) 466-470
4 Sangani SV, Parikh S. Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis?. A prospective observational study. Indian J Radiol Imaging 2015; 25 (02) 173-176
5 Robba C, Bacigaluppi S, Cardim D, Donnelly J, Bertuccio A, Czosnyka M. Non-invasive assessment of intracranial pressure. Acta Neurol Scand 2016; 134 (01) 4-21
6 Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 2008; 12 (03) R67
7 Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 2003; 10 (04) 376-381
8 Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, Semiz M. The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J 2007; 24 (04) 251-254
9 Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011; 15 (03) 506-515
10 Seo H, Kim YK, Shin WJ, Hwang GS. Ultrasonographic optic nerve sheath diameter is correlated with arterial carbon dioxide concentration during reperfusion in liver transplant recipients. Transplant Proc 2013; 45 (06) 2272-2276
11 Whitesell R, Asiddao C, Gollman D, Jablonski J. Relationship between arterial and peak expired carbon dioxide pressure during anesthesia and factors influencing the difference. Anesth Analg 1981; 60 (07) 508-512
12 Yosefy C, Hay E, Nasri Y, Magen E, Reisin L. End tidal carbon dioxide as a predictor of the arterial PCO₂ in the emergency department setting. Emerg Med J 2004; 21 (05) 557-559
13 Kim S, McNames J, Goldstein B. Intracranial pressure variation associated with changes in end-tidal CO2. Conf Proc IEEE Eng Med Biol Soc 2006; 1: 9-12
14 Hamilton DR, Sargsyan AE, Melton SL. et al. Sonography for determining the optic nerve sheath diameter with increasing intracranial pressure in a porcine model. J Ultrasound Med 2011; 30 (05) 651-659
15 Kim JY, Min HG, Ha SI, Jeong HW, Seo H, Kim JU. Dynamic optic nerve sheath diameter responses to short-term hyperventilation measured with sonography in patients under general anesthesia. Korean J Anesthesiol 2014; 67 (04) 240-245
16 Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008; 15 (02) 201-204