Prone pozisyonun optik sinir kılıfı çapına etkisi

Amaç: Optik sinir kılıfı çapı ölçümü kafa içi basınç artışının tespitinde noninvaziv, güvenilir bir yöntemdir. Biz çalışmamızda, ameliyathane ortamında sık kullanılan prone pozisyonun kafa içi basıncına etkisini araştırdık.Yöntemler: Prone pozisyonda vertebra operasyonu yapılacak toplam 60 beyin cerrahi ve ortopedi hastasının preoperatif indüksiyondan hemen önce ve postoperatif supine pozisyona alındığında ekstübasyondan önce ultrasonografi ile her iki gözde yatay ve dikey optik sinir kılıfı çapı ölçümlerini kaydettik. Cinsiyet, süre ve sağ göz- sol göz kıyaslamaları yapıldı.Bulgular: Cinsiyet ve sağ göz- sol göz kıyaslamalarında fark gözlenmedi. Süre açısından kısa süren olgularda optik sinir kılıfı çapında değişiklik yoktu. 240 dakikadan uzun süren olgularda istatistiksel olarak anlamlı olmasa da nümerik olarak bariz artış gözlendi.Sonuç: Prone pozisyonu kısa ve orta süreli operasyonlarda kafa içi basınç artışı yapmamaktadır. Ancak çok uzun süreli durumlarda optik sinir kılıfı çapı artma eğilimindedir. Bu nedenle çok uzun süre prone pozisyonda tutulan hastalarda kafa içi basınç artışı yönünden dikkatli olunmalıdır.

Anahtar Kelimeler:

kafa içi basınç artışı, optik sinir kılıfı çapı, ultrasonografi, prone pozisyon

The Impact of Prone Position on Optic Nerve Sheath Diameter

Aim: The measurement of optic nerve sheath diameter is a reliable and non-invasive approach in determining increased intracranial pressure (ICP). We investigated the impact of prone position, a frequently used approach during surgery, on ICP in this present study.Methods: Horizontal and vertical optic nerve sheath diameters for both eyes were measured by means of ultrasonography first immediately after intubation preoperatively and then when the patient has been placed in supine position prior to extubation postoperatively in a total of 60 patients scheduled for vertebral surgery in prone position in neurosurgical and orthopedic theatres. They were compared in terms of sex and duration as well as for left and right eye measurements.Results: No significant differences were observed in terms of sex as well as right-left eye measurements in the patients. No changes were noted in optic nerve sheath diameter in the patients with shorter operative duration. However, there was a notable increase numerically in patients who had operation duration of over 240 minutes, although the difference was not established to be statistically significant.Conclusion: Prone position was not associated with increased intracranial pressure in patients who undergo short or medium duration surgery. However, optic nerve sheath diameter is likely to increase in patients who undergo longer surgery. Therefore, care has to be taken in terms of elevated ICP in patients who remain in prone position for extended periods.

Keywords:

Intracranial pressure increase, optic nerve sheath diameter, ultrasonography, prone position,

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