Research Article
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Total diz protezi vaklarında spinal anestezi ve turnike kullanımının optik sinir çapı üzerine etkisi

Year 2023, Volume: 33 Issue: 1, 67 - 71, 28.02.2023
https://doi.org/10.54005/geneltip.1214376

Abstract

Giriş ve Amaç: Optik sinir kılıf çapı ölçümü, intrakranial basınç değerlendirmesini sağlayan ve hızlı
sonuç veren non-invazif bir yöntemdir. Bu çalışmadaki amacımız, total diz artroplastisi
ameliyatlarında , spinal anestezinin ve turnike kullanımının optik sinir kılıf çapı değerlerini nasıl
etkilediğini araştırmaktır.
Material ve Method: Çalışmaya 30 olgu dahil edildi, olguların demografik verileri kaydedildi. Spinal
anestezi yapıldıktan sonra turnike manşonu şişirildi. Sağ ve sol optik sinir kılıf çapları; spinal anestezi
öncesi, spinal anestezi sonrası , turnike şişirilmesi sonrası 10. dakikada, turnike şişirilmesi sonrası 30.
dakika ve turnike indirildikten sonra olmak üzere 5 kez okuler usg ile optik sinir kılıf çapı ölçümü
yapıldı. Ölçümler santimetre olarak kaydedildi.Postoperatif ilk 24 saatlik dönemde olguların başağrısı
ve /veya görme bozukluğu olup olmadığı takip edildi.
Bulgular: Vücut kitle indeksi, ameliyat süresi, turnike süresi, turnike basıncı ile spinal öncesi optik
sinir kılıf çap değerleri arasında istatistiksel olarak anlamlı bir ilişki bulunmamıştır (p>0.050). Spinal
anestezi öncesi ve sonrası optik sinir kılıf çapı değerleri arasında anlamlı fark tespit edilmiştir
(p<0.001, p<0.001). Zamana göre sağ-sol tarafta elde edilen optik çap, turnike ve turnike indirme
değerlerinin karşılaştırılması yapıldığında lineer bir artış olduğunu tespit ettik. Postoperatif ilk 24
saatlik dönemde , başağrısı ve /veya görme bozukluğu olan olguya rastlanmamıştır.
Sonuç: Spinal anestezi ve ortopedik cerrahide kullanılan turnike kullanımı intrakranial basıncı
artırmaktadır. Artmış intrakranial basınçta optik sinir kılıf çapını artırmaktadır. İntrakranial basınç
artışının tanı ve takibinde, optik sınır kılıf çapı ölçümü güvenle kullanılabilecek non-invaziv ve başarılı
bir yöntemdir. Anesteziyologların optik sinir kılıf çapı ölçümüne, klinik pratikte daha fazla yer vermesi
gerektiği inancındayız.

References

  • Aydemir AN, Yucens M. Trends in noncompartmental knee arthroplasty. Acta Ortop Bras. 2020;28(1):19–21.
  • Noordin PS, Mcewen J a, John C, Jr FK, Eisen A. Torniquetes quirúrgicos en Ortopedia. 2009;1–13. doi:10.2106/JBJS.I.00634
  • Odinsson A, Finsen V. Tourniquet use and its complications in Norway. The Journal of Bone Joint Surgery – British Volume 2006;88(8):1090–2.
  • Kimberly HH SS, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008;15(2):201-4.
  • Geeraerts T DJ, Benhamou D. Ocular sonography in patients with raised intracranial pressure: The papilloedema revisited. Crit Care 2008;12(3):1-2.
  • Amini A, Kariman H, Dolatabadi AA, Hatamabadi HR, Derakhshanfar H, Mansouri B, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. The American journal of emergency medicine. 2013;31(1):236-9.
  • Aksoy Y, Eyi YE. The Bedside Ultrasound: A Rapid Way of Measuring Optic Nerve Sheath Diameter in Emergency. J Emerg Med. 2016;51(2): e25-6
  • Komut E, Kozaci N, Sonmez BM, Yilmaz F, Komut S, Yildirim ZN, et al. Bed side sonographic measurement of optic nerve sheath diameter as a predictor of intra cranial pressure in ED. Am J Emerg Med. 2016;34(6):963-7.
  • Hassen GW, Kalantari H. In Response To: The Bedside Ultrasound: A Rapid Way of Measuring Optic Nerve Sheath Diameter in Emergency Medicine. J Emerg Med. 2016;51(2): e27-e28.
  • Dubost C, Le Gouez A, Jouffroy V, Roger-Christoph S, Benhamou D, Mercier FJ, et al. Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: a pilot study. Anaesthesiology. 2012;116(5):1066-71.
  • Besir A, Tertemiz OF, Akdoğan A, Duman EN. The Importance of Optic Nerve Sheath Diameter in Post-dural Puncture Headache Diagnosis and Follow up. Arch Neuropsychiatry 2019;56(3):195-9.
  • Wang L, Feng L, Yao Y, Wang Y, Feng J, Xing Y. Ultrasonographic Evaluation of Optic Nerve Sheath Diameter among Healthy Chinese Adults. Ultrasound Med Biol 2016; 42(3): 683-8
  • Kim DH, Jun J-S, Kim R. Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers. Scientific Reports 2017;7(1): 1-6 DOI:10.1038/s41598-017-16173-z
  • Schroeder C, Katsanos AH,Richter D,Tsivgoulis G ,Gold R, Krogias C.Quantification of Optic Nerve and Sheath Diameter by Transorbital Sonography: A Systematic Review and Metanalysis. J Neuroimaging, 2020; 30(2): 165-174
  • Goeres P, Zeiler FA, Unger B, KarakitsosD, Gillman LM. Ultrasound assessment of optic nerve sheath diameter in healthy volunteers. J CritCare, 2016; 31(1): 168-71
  • Thotakura AK, Marabathina NR, Danaboyina AR, Mareddy RR. Role of serial ultrasonic optic nerve sheath diameter monitoring in head injury. Neurochirurgie 2017; 63(6): 444-8
  • 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 anaesthesia. Korean J Anesthesiol. 2014;67(4):240-5. doi: 10.4097/kjae.2014.67.4.240. Epub 2014 Oct 27. PMID: 25368781; PMCID: PMC4216785.
  • Killer H, Laeng H, Flammer J, Groscurth P. Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. British Journal of Ophthalmology. 2003; 87(6):777-81.
  • Hamilton DR,Sargsyan AE,Melton SL,Garcia KM,Oddo B, Kwon DS et al.Sonography for determining the optic nerve sheath diameter with increasing intracranial pressure in a porcine model. Journal of Ultrasound in Medicine 2011;30(5): 651-9
  • Ertl M, Aigner R, Krost M, Karnasova Z, Muller K, Naumann M, et al. Measuring changes in the optic nerve sheath diameter in patients with idiopathic normal-pressure hydrocephalus: a useful diagnostic supplement to spinal tap tests. Eur J Neurol. 2017;24(3):461-7.

The Effects of Spinal Anaesthesia and Tourniquet Use on Optic Nerve Sheath Diameter in Total Knee Replacement Cases

Year 2023, Volume: 33 Issue: 1, 67 - 71, 28.02.2023
https://doi.org/10.54005/geneltip.1214376

Abstract

Abstract:
Backgraound: Optic nerve sheath diameter measurement is a non-invasive method that provides rapid results in intracranial pressure assessment. Our aim in this study is to investigate how spinal anesthesia and tourniquet use affect optic nerve sheath diameter values in total knee arthroplasty operations.
Methods:30 cases were included in the study. After spinal anesthesia, the tourniquet cuff was inflated. Right and left optic nerve sheath diameter measurements were performed 5 times with ocular ultrasound before spinal anesthesia, after spinal anesthesia, at 10th minutes after tourniquet inflation, 30th minutes after tourniquet inflation, and after tourniquet was deflated. The measurements were recorded in centimeters. During the first 24 hours postoperatively, the patients were followed up for the headache and/or visual impairment.
Results: A significant difference was found between optic nerve sheath diameter values before and after spinal anesthesia (p<0.001, p<0.001). When comparing the optical diameter, tourniquet and tourniquet deflation values obtained on the right and left sides over time, we found a linear increase.
Conclusion: The use of a tourniquet in spinal anesthesia and orthopedic surgery increases intracranial pressure. Optical measurement of nerve sheath diameter is a non-invasive and successful method that can be used safely for diagnosis and follow-up of elevated intracranial pressure. We believe that anesthesiologists should pay more attention to the measurement of optic nerve sheath diameter in clinical practice.

References

  • Aydemir AN, Yucens M. Trends in noncompartmental knee arthroplasty. Acta Ortop Bras. 2020;28(1):19–21.
  • Noordin PS, Mcewen J a, John C, Jr FK, Eisen A. Torniquetes quirúrgicos en Ortopedia. 2009;1–13. doi:10.2106/JBJS.I.00634
  • Odinsson A, Finsen V. Tourniquet use and its complications in Norway. The Journal of Bone Joint Surgery – British Volume 2006;88(8):1090–2.
  • Kimberly HH SS, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008;15(2):201-4.
  • Geeraerts T DJ, Benhamou D. Ocular sonography in patients with raised intracranial pressure: The papilloedema revisited. Crit Care 2008;12(3):1-2.
  • Amini A, Kariman H, Dolatabadi AA, Hatamabadi HR, Derakhshanfar H, Mansouri B, et al. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. The American journal of emergency medicine. 2013;31(1):236-9.
  • Aksoy Y, Eyi YE. The Bedside Ultrasound: A Rapid Way of Measuring Optic Nerve Sheath Diameter in Emergency. J Emerg Med. 2016;51(2): e25-6
  • Komut E, Kozaci N, Sonmez BM, Yilmaz F, Komut S, Yildirim ZN, et al. Bed side sonographic measurement of optic nerve sheath diameter as a predictor of intra cranial pressure in ED. Am J Emerg Med. 2016;34(6):963-7.
  • Hassen GW, Kalantari H. In Response To: The Bedside Ultrasound: A Rapid Way of Measuring Optic Nerve Sheath Diameter in Emergency Medicine. J Emerg Med. 2016;51(2): e27-e28.
  • Dubost C, Le Gouez A, Jouffroy V, Roger-Christoph S, Benhamou D, Mercier FJ, et al. Optic nerve sheath diameter used as ultrasonographic assessment of the incidence of raised intracranial pressure in preeclampsia: a pilot study. Anaesthesiology. 2012;116(5):1066-71.
  • Besir A, Tertemiz OF, Akdoğan A, Duman EN. The Importance of Optic Nerve Sheath Diameter in Post-dural Puncture Headache Diagnosis and Follow up. Arch Neuropsychiatry 2019;56(3):195-9.
  • Wang L, Feng L, Yao Y, Wang Y, Feng J, Xing Y. Ultrasonographic Evaluation of Optic Nerve Sheath Diameter among Healthy Chinese Adults. Ultrasound Med Biol 2016; 42(3): 683-8
  • Kim DH, Jun J-S, Kim R. Ultrasonographic measurement of the optic nerve sheath diameter and its association with eyeball transverse diameter in 585 healthy volunteers. Scientific Reports 2017;7(1): 1-6 DOI:10.1038/s41598-017-16173-z
  • Schroeder C, Katsanos AH,Richter D,Tsivgoulis G ,Gold R, Krogias C.Quantification of Optic Nerve and Sheath Diameter by Transorbital Sonography: A Systematic Review and Metanalysis. J Neuroimaging, 2020; 30(2): 165-174
  • Goeres P, Zeiler FA, Unger B, KarakitsosD, Gillman LM. Ultrasound assessment of optic nerve sheath diameter in healthy volunteers. J CritCare, 2016; 31(1): 168-71
  • Thotakura AK, Marabathina NR, Danaboyina AR, Mareddy RR. Role of serial ultrasonic optic nerve sheath diameter monitoring in head injury. Neurochirurgie 2017; 63(6): 444-8
  • 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 anaesthesia. Korean J Anesthesiol. 2014;67(4):240-5. doi: 10.4097/kjae.2014.67.4.240. Epub 2014 Oct 27. PMID: 25368781; PMCID: PMC4216785.
  • Killer H, Laeng H, Flammer J, Groscurth P. Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. British Journal of Ophthalmology. 2003; 87(6):777-81.
  • Hamilton DR,Sargsyan AE,Melton SL,Garcia KM,Oddo B, Kwon DS et al.Sonography for determining the optic nerve sheath diameter with increasing intracranial pressure in a porcine model. Journal of Ultrasound in Medicine 2011;30(5): 651-9
  • Ertl M, Aigner R, Krost M, Karnasova Z, Muller K, Naumann M, et al. Measuring changes in the optic nerve sheath diameter in patients with idiopathic normal-pressure hydrocephalus: a useful diagnostic supplement to spinal tap tests. Eur J Neurol. 2017;24(3):461-7.
There are 20 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Article
Authors

Zübeyir Cebeci 0000-0001-7862-4268

Ebru Canakci 0000-0003-2093-9229

Publication Date February 28, 2023
Submission Date December 4, 2022
Published in Issue Year 2023 Volume: 33 Issue: 1

Cite

Vancouver Cebeci Z, Canakci E. The Effects of Spinal Anaesthesia and Tourniquet Use on Optic Nerve Sheath Diameter in Total Knee Replacement Cases. Genel Tıp Derg. 2023;33(1):67-71.

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