Evaluation of the Effect of Propofol Total Intravenous Anesthesia versus Sevoflurane or Desflurane Inhalational Anesthesia on Optic Nerve Sheath Diameter in Laparoscopic Gynecologic Surgeries in Trendelenburg Position: A Randomized Study
Anjali Gera, Ashwin Marwaha, Anjeleena K. GuptaAbstract
Background:
Laparoscopic gynecological surgeries in the Trendelenburg position with CO 2 pneumoperitoneum (PNP) can elevate intracranial pressure (ICP) and compromise cerebral perfusion pressure, heightening ischemia risk. Measuring optic nerve sheath diameter (ONSD) through ultrasound provides a reliable, noninvasive method for ICP monitoring. This study compares the effects of propofol (total intravenous anesthesia [TIVA]), sevoflurane, and desflurane on ONSD to enhance anesthesia management during these surgeries.
Materials and Methods:
Conducted at Sir Ganga Ram Hospital in New Delhi, this randomized study involved 75 female patients (aged 18–65, American Society of Anesthesiologists I–III) scheduled for laparoscopic gynecological surgery. Participants were divided into three groups: D, P, and S. Anesthesia induction used propofol and atracurium, followed by agent-specific maintenance. ONSD was measured at various intervals: postinduction (T0), post-PNP (T1), after Trendelenburg position (T2), and at 30, 60 min, and after PNP release (T3–T5).
Results:
ONSD increased up to 60 min after Trendelenburg and was significantly higher in Group S at T3 (
Conclusion:
This study identified significant differences in ONSD, sedation levels, and recovery times among the groups, with sevoflurane associated with increased ICP and longer recovery. These findings highlight the need for further research to optimize anesthesia techniques for surgical procedures in the Trendelenburg position.