The effect of obesity on optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery: a prospective observational study.

PURPOSE

Pneumoperitoneum and the steep Trendelenburg position during laparoscopic gynecological surgery may increase intracranial pressure, which can be estimated using ultrasound measurement of the optic nerve sheath diameter (ONSD). In this study, we evaluated the effect of obesity on ONSD in patients undergoing laparoscopic gynecological surgery.

METHODS

Sixty-eight patients who underwent laparoscopic gynecological surgery were allocated to either the non-obese (n = 34) or obese (n = 34) groups. ONSD was assessed using ultrasound after anesthesia induction, at 30 and 60 min after pneumoperitoneum and Trendelenburg positioning, and at 10 and 60 min, and 24 h after desufflation and return to the supine position. Postoperative nausea and vomiting (PONV) and headache were evaluated 1 and 24 h after surgery.

RESULTS

ONSD increased significantly during pneumoperitoneum and Trendelenburg positioning in both groups (P < 0.001, respectively) and was higher in the obese group at each time point throughout and after surgery (P < 0.007, respectively). The increased ONSD during surgery returned to baseline 24 h after desufflation in the non-obese group, but not in the obese group. The incidence of PONV 1 h after surgery was significantly higher in the obese group than in the non-obese group (59% vs. 21%, respectively; P = 0.001). The incidence of PONV 24 h after surgery and postoperative headaches were not different between the two groups.

CONCLUSION

ONSD was significantly higher in the obese group than in the non-obese group throughout and after laparoscopic gynecological surgery. The increased ONSD during surgery did not return to baseline even 24 h after desufflation in the obese group.