The effect of positive end-expiratory pressure on optic nerve diameter in patients undergoing craniotomy operation

Abstract

Aim: In this study, we aimed to investigate the effect of PEEP on changes in intracranial pressure with the guidance of ultrasonographic measurement of the optic nerve, in patients who underwent craniotomy operation in the supine position. Material(s) and Method(s): A total of 60 patients evaluated as ASA I-II and who were scheduled for craniotomy operation in the supine position under elective conditions were included in the study. Following routine monitorization of anesthesia induction, patients were provided with 1 mcg/kg iv fentanyl, 3 mg/kg iv thiopental sodium, 0.6 mg/kg iv rocuronium. Anesthesia maintenance was then provided with 2% sevoflurane and remifentanil (0,05-2 mcg/kg/min) infusion to keep BIS between 40 and 65. Patients in Group I received a 5 cmH2 O PEEP, while those in Group II received 0 cmH2 O PEEP. Patients' HR, SAP, DAP, MAP, end-tidal carbon dioxide (ETCO2), SpO2, Ppeak, Pmean, minute volume, Tv expiratory, ONSD values were measured at following time-points: T0-before anesthesia induction, T1-after the dura is opened, T2-immediately before the dura is closed, T3-before extubation. Result(s): There was no statistical difference in hemodynamic parameters (SAP, DAP, MAP) between the two groups (p>0.05). ONSD was similar between both groups at all time points except for T2 results. The mean ONSD at T2 was significantly higher in Group I (p=0.04). Ppeak and Pmean were significantly higher in Group I at all time points (p<0.05). Discussion(s): We investigated the effect of PEEP on the optic nerve sheath diameter and its indirect effect on intracranial pressure; we revealed that two different PEEP levels did not create a difference.Copyright © 2021, Derman Medical Publishing. All rights reserved.