Evaluation of Changes in Optic Nerve Diameter in Obese Patients Undergoing Laparoscopic Surgery

Abstract

Aim: During laparoscopic surgery (LC), intracranial pressure increases due to factors such as pneumoperitoneum (PP) and Trendelenburg position (TP). Measurement of the optic nerve sheath diameter is an important indicator of intracranial pressure. In this study, we compared the optic nerve diameter measurement (ONSD) during laparoscopic surgery in obese and normal weight individuals.
Material and Methos: The search included 99 ills who underwent laparoscopic surgery at Malatya Training and Research Hospital. Optic nerve sheath age measurements were performed preoperatively, post-intubation, post-pneumoperitoneum, and post-extubation in obese (n: 50) and control group (n: 49) patients who underwent laparoscopic surgery. Additionally, operation information and demographic data were recorded.
Result: We included 99 patients in the study. The data analysis we obtained in this study showed that although ONSD values were similar between the groups at T0 and T1 (p>0.05), they were wider in obese individuals at T2 and T3 (respectively p <0.001, p=0.044). In the within-group analysis; although there was an increase compared to T0 in the obese group at T1 and T2, there was a decrease compared to T2 at T3 (p<0.001). In normal-weight patients, the within-group measured T-times were similar to those in the obese group.  In the statistical analysis performed using the SPSS 23.0 statistical package, Skewness and Kurtosis test, t-test, Mann-Whitney U test and ANOVA were used.
Conclusion: Results of the analysis of research data; PP and TP in LC Cause increased intracranial pressure. In order to prevent possible complications, it is important to provide lower PP pressure, keep the operation time as short as possible, and keep EtCO2 within normal limits by making mechanical ventilator adjustments.

Keywords

• Intracranial pressure
• optic nerve diameter
• obesity
• pneumoperitoneum
• trendelenburg position

References

1. 1. Park EY, Koo BN, Min KT, Nam SH. The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand. 2009 53(7):895-9. doi:10.1111/j.1399-6576.2009.01991.x.
2. 2. Washko GR, O'Donnell CR, Loring SH. Volume-related and volume-independent effects of posture on oesophageal and transpulmonary pressures in healthy subjects. J Appl Physiol (1985). 2006;100(3):753-8. doi:10.1152/japplphysiol.00697.2005.
3. 3. Hasirci I, Ulutas E, Polat A, Harb A, Tire Y, Kartal A. Comparison of extraperitoneal and intraperitoneal laparoscopic procedures for intracranial pressure increase: a prospective clinical study. Eur Rev Med Pharmacol Sci. 2023;27(13):6207-14. doi: 10.26355/eurrev_202307_32979.
4. 4. Hannerz J, Ericson K. The relationship between idiopathic intracranial hypertension and obesity. Headache. 2009; 49(2):178-84. doi:10.1111/j.1526-4610.2008.01240.x.
5. 5. Sujata N, Tobin R, Mehta P, Girotra G. Optic nerve sheath diameter-guided extubation plan in obese patients undergoing robotic pelvic surgery in steep Trendelenburg position: a report of three cases. Indian J Anaesth. 2018;62(11):896-9. doi:10.4103/ija.IJA_370_18.
6. 6. Caglià P, Tracia A, Buffone A, Amodeo L, Tracia L, Amodeo C, et al. Physiopathology and clinical considerations of laparoscopic surgery in the elderly. Int J Surg. 2016;33 Suppl 1:S97-102. doi:10.1016/j.ijsu.2016.05.044.
7. 7. Pelloni M, Afonso-Luís N, Marchena-Gomez J, Piñero-González L, Ortíz-López D, Acosta-Mérida MA, et al. Comparative study of postoperative complications after open and laparoscopic surgery of the perforated peptic ulcer: Advantages of the laparoscopic approach. Asian J Surg. 2022;45(4):1007-13. doi:10.1016/j.asjsur.2021.08.059.
8. 8. Hayden P, Cowman S. Anaesthesia for laparoscopic surgery. Continuing Education in Anaesthesia Critical Care & Pain 2011;11(5):177-80. doi:10.1093/bjaceaccp/mkr027.

9. 9. Gülleroglu A, Turgut N, Vatansever S, Tekin Aktaş E, Altan A. Laparoskopik kolesistektomi operasyonlarında karın içi basınç artışının solunum mekaniği, hemodinami ve metabolizma üzerindeki etkileri. Okmeydanı Tıp Dergisi. 2015;31(3):134-43. doi:10.5222/otd.2015.1005.
10. 10. Emmez G, Karabıyık L, Özdek Ş. Effects of non-laryngoscopy and standard laryngoscopic intubation methods on hemodynamic responses and intraocular pressure. JARSS Anestezi Dergisi. 2022;30(2):127-33. doi:10.54875/jarss.2022.49091.
11. 11. Grabarczyk Ł, Wen-Tau H, Rymsza M, Stankiewicz A, Dobrzeniecka-Al Dhaif M, Szewczyk M. Skeletal muscle relaxants and their impact on intracranial pressure in neurosurgery. Med Sci Monit. 2025;31:e946569. doi:10.12659/MSM.946569.
12. 12. Hypolito O, Azevedo JL, Gama F, Azevedo O, Abe Miyahira S, Pires OS. Efeitos da pressão do pneumoperitôneo artificial elevada sobre a pressão arterial invasiva e os níveis dos gases sanguíneos. Rev Bras Anestesiol. 2014;64(2):98-104. doi:10.1016/j.bjan.2013.03.020.
13. 13. Veekash G, Wei LX, Su M. Carbon dioxide pneumoperitoneum, physiologic changes and anesthetic concerns. Ambulatory Surgery 2010;16(2):41-6.
14. 14. Polat C, Yilmaz S, Akbulut G, Erol Dogan D, Arikan Y, Dilek ON, et al. Laparoskopik cerrahide pnömoperitonun sistemik etkileri. End Lap Minimal İnvaziv Cerrahi. 2003;10(1-2):13-22.
15. 15. Robba, C, Bacigaluppi S, Cardim D, Donnelly J, Sekhon MS, Aries MJ, et al. Intraoperative non invasive intracranial pressure monitoring during pneumoperitoneum: a case report and a review of the published cases and case report series. J Clin Monit Comput. 2016;30(5):527-38. doi:10.1007/s10877-015-9765-9.
16. 16. Özdemir-van Brunschot DM, van Laarhoven KC, Scheffer GJ, Pouwels S, Wever KE, Warlé MC. What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review. Surg Endosc. 2016;30(5):2049-65. doi:10.1007/s00464-015-4454-9.
17. 17. Sahay N, Sharma S, Bhadani UK, Singh A, Sinha C, Sahay A, et al. Effect of pneumoperitoneum and patient positioning on ıntracranial pressures during laparoscopy: a prospective comparative study. J Minim Invasive Gynecol. 2018;25(1):147-52. doi:10.1016/j.jmig.2017.07.031.
18. 18. Kim MS, Bai SJ, Lee JR, Choi YD, Kim YJ, Choi SH. Increase in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol. 2014;28(7):801-6. doi:10.1089/end.2014.0019.
19. 19. Verdonck P, Kalmar AF, Suy K, Geeraerts T, Vercauteren M, Mottrie A, et al. Optic nerve sheath diameter remains constant during robot assisted laparoscopic radical prostatectomy. PLoS One. 2014;9(11):e111916. doi:10.1371/journal.pone.0111916. Erratum in: PLoS One. 2015;10(2):e0118014. doi:10.1371/journal.pone.0118014.
20. 20. Kim, SH, Kim, HJ, & Jung, KT. Position does not affect the optic nerve sheath diameter during laparoscopy. Korean Journal of Anesthesiology 2015;68(4):358-63. doi:10.4097/kjae.2015.68.4.358.
21. 21. Kim MS, Bai SJ, Lee JR, Choi YD, Kim YJ, Choi SH. Increase in intracranial pressure during Carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter. J Endourol. 2014;28(7):801-6. doi:10.1089/end.2014.0019.
22. 22. Joseph A, Theerth KA, Karipparambath V, Palliyil A. Effects of pneumoperitoneum and Trendelenburg position on intracranial pressure and cerebral blood flow assessed using transcranial doppler: a prospective observational study. J Anaesthesiol Clin Pharmacol. 2023;39(3):429-34. doi:10.4103/joacp.joacp_531_21.
23. 23. Iwasaka H, Miyakawa H, Yamamoto H, Kitano T, Taniguchi K, Honda N. Respiratory mechanics and arterial blood gases during and after laparoscopic cholecystectomy. Can J Anaesth. 1996;43(2):129-33. doi:10.1007/BF03011253.