Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.12.006
Brazilian Journal of Anesthesiology
Original Investigation

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Os efeitos da aplicação de pressão expiratória final positiva (PEEP) no diâmetro da bainha do nervo óptico em pacientes submetidos à colecistectomia laparoscópica: um ensaio randomizado

Seher Yanatma, Reyhan Polat, Mehmet Murat Sayın, Safinaz Karabayırlı

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Abstract

Background
Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy.

Methods
Eighty ASA I–II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH20). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter.

Results
Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001).

Conclusions
During laparoscopic cholecystectomy, application of 10 cmH2O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct respiratory mechanics in cases of laparoscopic cholecystectomy, with no significant effect on optic nerve sheath diameter.

Keywords

Laparoscopic cholecystectomy;  Pneumoperitoneum;  Positive end-expiratory pressure;  Optic nerve sheath diameter;  Ocular ultrasonography

Resumo

Introdução

A pressão expiratória final positiva (PEEP) pode superar as alterações respiratórias que ocorrem durante a aplicação do pneumoperitônio em procedimentos laparoscópicos, mas também pode aumentar a pressão intracraniana. Nós investigamos PEEP versus nenhuma aplicação de PEEP na medição ultrassonográfica do diâmetro da bainha do nervo óptico (medida indireta do aumento da pressão intracraniana) na colecistectomia laparoscópica.

Métodos

Foram incluídos 80 pacientes, estado físico ASA I–II, com idade entre 18 e 60 anos, agendados para colecistectomia laparoscópica eletiva. O estudo foi registrado no Australian New Zealand Clinical Trials (ACTRN12618000771257). Os pacientes foram divididos aleatoriamente em Grupo C (controle, PEEP não aplicada) ou Grupo P (PEEP aplicada a 10 cmH20). O diâmetro da bainha do nervo óptico, os parâmetros hemodinâmicos e respiratórios foram registrados em seis momentos diferentes. A ultrassonografia ocular foi utilizada para medir o diâmetro da bainha do nervo óptico.

Resultados

Os valores de pico de pressão (PPeak) foram significativamente maiores no Grupo P após aplicação da PEEP (p = 0,012). A frequência respiratória média foi maior no Grupo C em todos os momentos após a aplicação do pneumoperitônio (p < 0,05). Os valores médios dos diâmetros da bainha do nervo óptico medidos em todos os momentos foram semelhantes entre os grupos (p > 0,05). O valor da complacência dinâmica pulmonar foi significativamente maior no grupo P desde que aplicada PEEP (p = 0,001).

Conclusão

Durante a colecistectomia laparoscópica, a aplicação de PEEP de 10 cmH2O não induziu alteração significativa no diâmetro da bainha do nervo óptico (indicador indireto de pressão intracraniana) em comparação com nenhuma aplicação de PEEP. Parece que a PEEP pode ser usada com segurança para corrigir a mecânica respiratória em casos de colecistectomia laparoscópica, sem efeito significativo no diâmetro da bainha do nervo óptico.

Palavras-chave

Colecistectomia laparoscópica; Pneumoperitônio; Pressão expiratória final positiva; Diâmetro da bainha do nervo óptico; Ultrassonografia ocular

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Submitted date:
12/12/2020

Accepted date:
12/19/2021

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