Assessment of brain edema occurrence during laparoscopic radical resection of gynecological tumor: measurement of optic nerve sheath diameter by ultrasound method

Abstract

Objective To assess whether brain edema occurred during laparoscopic radical resection of gynecological tumor through measurement of optic nerve sheath diameter (ONSD) by ultrasound. Methods Forty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 35-64 yr, with body mass index of 18.5-25.0 kg/m2, scheduled for elective laparoscopic radical resection of gynecologic tumor, were divided into 2 groups (n=20 each) using a random number table method: hypertonic sodium chloride hydroxyethyl starch 40 injection (HSH40) therapeutic diagnosis group (group H) and normal saline control group (group N). HSH40 5ml/kg was continuously infused for 30 min starting from 150 min after Trendelenburg position and CO2 pneumoperitoneum in group H, and the equal volume of normal saline was given instead in group N. The bilateral ONSDs were measured using ultrasound at 5 min after anesthesia induction (T0), 10, 60, 120 and 180 min after Trendelenburg position and CO2 pneumoperitoneum (T1-4) and 10 min of supine position after deflation (T5). The occurrence of increased intracranial pressure before and after therapeutic diagnostic test and efficacy of therapeutic diagnostic test were observed. Results The ONSD was significantly shorter at T4-5 in group H than in group N (P 0.05). The effective rate of therapeutic diagnostic test was 94% in group H (P<0.05). Conclusion Laparoscopic radical resection of gynecologic tumor factor can induce brain edema, and preventive measures should be taken. Key words: Brain Edema; Pneumoperitoneum, artificial; Gynecologic surgical procedures; Optic nerve; Neurilemma