Case Series
Year: 2022 | Month: October-December | Volume: 7 | Issue: 4 | Pages: 148-152
DOI: https://doi.org/10.52403/ijshr.20221020
The Effect of Laryngoscope Types on Hemodynamic Response and Intracranial Pressure by ONSD Measurement in Neurosurgery at Sanglah General Hospital: A Case Series
Gde Candra Yogiswara1, Ida Bagus Krisna Jaya Sutawan2
1Resident of Anesthesiologist and Intensive Care Department of Udayana University, Denpasar, Indonesia
2Neuroanaesthesiologist Consultant of Anesthesiologist and Intensive Care Department of Udayana University, Denpasar, Indonesia
Corresponding Author: Gde Candra Yogiswara
ABSTRACT
Object: Endotracheal intubation is the gold standard for ensuring a safe airway when applying general anesthesia. Endotracheal intubation can cause an increase in intracranial pressure (ICP). Ultrasound measurement of optic nerve sheath diameter (ONSD) is known as an accurate monitor of increased intracranial pressure. However, it is not known how the ICP fluctuations are caused by endotracheal intubation using various types of laryngoscopy. Therefore, the authors investigated the hemodynamic changes and intracranial pressure caused by the two types of laryngoscope used for endotracheal intubation in neurosurgical patients undergoing general anesthesia.
Cases: The authors report 4 patients as a case series from the Central Operating Theatre (COT) of Sanglah General Hospital, Denpasar, Bali. We were performed optical nerve sheath diameter (ONSD) measurements on both eyeballs of those patients. All of the patients were performed general anaesthesia with endotracheal intubation. Correlation between ONSD and ICP measurements was determined, and changes were seen based on baseline data obtained from before intubation to 10 minutes after intubation. Sheath diameter more than 5.5 mm had a higher ICP value predicate than 15 mmHg with 100% sensitivity (95% CI, 100-100) and 100% specificity (95% CI, 100-100).
Discussion: Our case series demonstrated a change in ICP in each patient endotracheal intubation with a McGrath video laryngoscope and a Macintosh laryngoscope, then the authors examined the optic nerve sheath by performing ultrasonography after induction before intubation (T0), 1 minute (T1), 3 minutes (T3), 5 minutes (T5) and 10 minutes after intubation (T10), which is known to increase ICP. In all patients ICP increased above normal values in baseline. There was a difference in diameter between the right and left eyes according to the location of each tumor. During tracheal manipulation, at first minute there was an increase in diameter in both eyes with ONSD increasing > 0,5 mm from the baseline value, and starting to decrease at 3, 5 minutes, and approaching or equal to the baseline value at 10 minutes.
Conclusion: In neurosurgical patients undergoing general anesthesia with endotracheal intubation, laryngoscopy is unavoidable, the use of the type of laryngoscope should be carefully considered in order to select and use a better type of laryngoscope to prevent hemodynamic shock. Hemodynamic monitoring with patient monitors and ONSD ultrasonography is an accurate, simple, and rapid measure to detect ICP elevations and ICP changes in real time. Therefore, ONSD could be a useful tool for monitoring ICP, especially in conditions where invasive ICP monitoring is not available.
Keywords: laryngoscope, hemodinamik, intracranial, ONSD, neurosurgery