Comparison of the Effects of Different PEEP Values With USG on Optic Nerve Sheath Diameter

Baskent University

Status: Not yet enrolling

Conditions: Cholecystitis

Treatments: Other: desufflation; Other: insufflation

Study type: Interventional

Funder types: Other

Identifiers

NCT06224868

KA 23/230

Details and patient eligibility

About

Laparoscopic surgeries are now more popular because of the advantages such as shorter hospital stay, minimal scar. In order to perform laparoscopic surgery, pneumoperitoneum should be initiated. The optic nerve sheath is an extension of the dura mater and the subarachnoid space is continuous with the intracranial subarachnoid space. Therefore, non-invasive monitoring of the increase in intracranial pressure (ICP) can be achieved by measuring the optic nerve and sheath diameter with ultrasound. Since ONSD measurement with ultrasound is an easily applicable technique, it is useful in monitoring intracranial pressure changes based on the optic nerve diameter during intraoperative changes

Full description

Laparoscopic surgeries are now becoming increasingly common compared to traditional laparotomies, as they have advantages such as more minimal scarring, shorter hospital stay, fewer complications, and early mobilization. In these surgeries, pneumoperitoneum provided with carbon dioxide (CO2) has many effects on the cardiovascular, pulmonary, renal, metabolic and cerebral systems. Pulmonary compliance and functional residual capacity decrease due to pnemoperitoneum, ventilation/perfusion mismatch occurs, and as a result, hypoxemia may occur. A minimum of 4-6 cm H20 positive end-expiratory pressure (PEEP) should be applied to all intubated patients under general anesthesia to reduce postoperative pulmonary complications (especially atelectasis) and prevent ventilation/perfusion mismatch and hypoxemia. The optic nerve sheath is an extension of the dura mater and the subarachnoid space is continuous with the intracranial subarachnoid space. Therefore, non-invasive monitoring of the increase in intracranial pressure (ICP) can be achieved by measuring the optic nerve and sheath diameter with ultrasound. When ICP is > 20 mm Hg, measuring the optic nerve sheath diameter (ONSD) between 5.2 and 5.9 mm has a sensitivity of 74-95% and a specificity of 74-100%. Since ONSD measurement with ultrasound is an easily applicable technique, it is useful in monitoring intracranial pressure changes based on the optic nerve diameter during intraoperative changes (trendelenburg/reverse trendelenburg position, pneumoperitoneum , PEEP in mechanical ventilation).

Enrollment: 45 estimated patients

Sex: All

Ages: 18 to 65 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 18- 65 aged all female and male volunteers

Exclusion criteria

• acute or chronic eye diseases,
• uncontrolled hypertension,
• asthma
• known lung disease,
• body mass index (BMI) over 35 kg/m2,
• devices using bulbs with known intracranial charging,
• who refuse to participate in care

Trial design

Primary purpose: Diagnostic

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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45 participants in 3 patient groups

PEEP 0

Active Comparator group

Description:

After the patient is intubated, PEEP 0 will be set on the mechanical ventilator.

Treatment:

Other: insufflation

Other: desufflation

PEEP 5

Active Comparator group

Description:

After the patient is intubated, PEEP 5 will be set on the mechanical ventilator.

Treatment:

Other: insufflation

Other: desufflation

PEEP 10

Active Comparator group

Description:

After the patient is intubated, PEEP 10 will be set on the mechanical ventilator.

Treatment:

Other: insufflation

Other: desufflation