Assessment of Optic Nerve Sheath Diameter in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography: A Prospective, Randomized, Controlled Double-Blinded Comparison of Propofol and Ketofol Anesthesia.

BACKGROUND: ERCP is an endoscopic procedure for the diagnosis and treatment of biliopancreatic system diseases. An increase in intra-abdominal pressure due to the insufflation of air to the intestinal lumen may be transmitted to ICP through the course of ERCP. In this prospective, randomized, controlled double-blinded study, we aimed to assess the ICP change using ultrasonography measurement of ONSD in patients undergoing ERCP comparing the effects of propofol and ketofol anesthesia. MATERIAL/METHODS: One hundred and nine patients undergoing ERCP under propofol or ketofol anesthesia were enrolled in the study. Ultrasonography measurement of ONSD was performed before (T0) and immediately after induction of anesthesia (T1), during sphincterotomy (T2), at the end of procedure (T3), and after the patient is fully awake (T4). RESULTS: Comparison of ONSD values and ONSD alteration between groups showed no statistically significant difference (P > 0.05). Both groups showed significantly greater changes from T0 to T2 compared with values from T0 to T1, T3, and T4, respectively (P = 0,000). T0 to T3 alteration was also significantly greater than T0 to T1 and T4 change in both groups (P = 0,000). CONCLUSIONS: ERCP procedure increases intracranial pressure most prominently during sphincterotomy both under propofol or ketofol anesthesia. Further studies are needed to investigate the impact of this phenomenon on adverse clinical outcomes.

Ultrasonographic evaluation of the postoperative airway edema after robotic prostatectomy: a single center observational study.

OBJECTIVE: During general anesthesia, different parts of the upper airway can change for various reasons, such as intravenous fluids, airway trauma due to airway devices used, stasis in tissues due to position, reactions to medications used, etc. For many reasons, edema in the airway or the surrounding tissue can narrow the airway. This study compares preoperative and postoperative ultrasound measurements of upper airway anatomy in patients with robotic radical prostatectomy in the Trendelenburg position. PATIENTS AND METHODS: This study was conducted at the Health Sciences University Ankara City Hospital between May and December 2022. The preoperative and postoperative measurements of tongue thickness, midsagittal tongue cross-sectional area, tongue width, lateral pharyngeal wall thickness, parapharyngeal region thickness, and submental region thickness were analyzed and compared. RESULTS: There was a difference between the preoperative and postoperative median sagittal tongue cross-sectional area, tongue volume values, LPW values, parapharyngeal region thickness, and neck circumference values. We found that the thickness of the submental region and the thickness of the parapharyngeal region increased as the amount of fluid administered intraoperatively increased. CONCLUSIONS: Upper airway edema is the most challenging problem for anesthetists during extubation due to position and pneumoperitoneum. Restrictive fluid management may have beneficial effects in preventing clinically important airway edema.