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Optic nerve sheath diameter changes during gynecologic surgery in the Trendelenburg position: comparison of propofol-based total intravenous anesthesia and sevoflurane anesthesia
Anesth Pain Med 2019;14(4):393-400
Published online October 31, 2019
© 2019 Korean Society of Neuroscience in Anesthesiology and Critical Care.

Youn Young Lee , Heeseung Lee , Hahck Soo Park , Won Joong Kim , Hee Jung Baik , and Dong Yeon Kim
Department of Anesthesiology and Pain Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Correspondence to: Heeseung Lee, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea Tel: 82-2-2650-2670 Fax: 82-2-2655-2924 E-mail:
Received January 4, 2019; Revised March 27, 2019; Accepted April 17, 2019.
cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Elevated intracranial pressure (ICP), a disadvantage of laparoscopic or robotic surgery, is caused by the steep angle of the Trendelenburg position and the CO2 pneumoperitoneum. Recently, sonographically measured optic nerve sheath diameter (ONSD) was suggested as a simple and non-invasive method for detecting increased ICP. This study aimed to explore the changes in ONSD in relation to different anesthetic agents used in gynecologic surgery.
Methods: Fifty patients were randomly allocated to two groups, sevoflurane (group SEV, n = 25) and propofol-based total intravenous anesthesia (TIVA) group (group TIVA, n = 25). The ONSD was measured at five time points (T0–T4): T0 was measured 5 min after induction of anesthesia in the supine position; T1, T2, and T3 were measured at 5, 15, and 30 min after CO2 pneumoperitoneum induction in the Trendelenburg position; and T4 was measured at 5 min after discontinuation of CO2 pneumoperitoneum in the supine position. Respiratory and hemodynamic variables were also recorded.
Results: The intra-group changes in mean ONSD in the Trendelenburg position were significantly increased in both groups. However, inter-group changes in mean ONSD were not significantly different at T0, T1, T2, T3, and T4. Heart rates in group TIVA were significantly lower than those in group SEV at points T1–T4.
Conclusions: There was no significant difference in the ONSD between the two groups until 30 min into the gynecologic surgery with CO2 pneumoperitoneum in the Trendelenburg position. This study suggests that there is no difference in the ONSD between the two anesthetic methods.
Key Words : Gynecologic surgical procedures; Optic nerve; Propofol; Sevoflurane; Ultrasonography.

October 2019, 14 (4)
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