Optik Sinir Kılıf Çapı Ölçümünün Anestezide Kullanım Alanları
Synopsis
Although invasive methods are considered the gold standard for detecting increased intracranial pressure (ICP), non-invasive and reliable techniques such as ultrasound-guided optic nerve sheath diameter (ONSD) measurement have come to the fore due to risks like bleeding and infection. ONSD measurement is performed with the patient in a supine position with the head elevated 20-30 degrees, using a high-frequency linear ultrasound probe by averaging four separate measurements taken 3 mm behind the eyeball in the transverse and sagittal planes. In adults, threshold values between 5.0 and 5.9 mm indicate elevated ICP, while age-specific thresholds are defined for pediatric patients. In general clinical practice, ONSD measurement is successfully used to monitor ICP in idiopathic intracranial hypertension, intracranial hypotension, evaluation of epidural blood patch efficacy, meningitis, encephalitis, mushroom poisoning-related encephalopathy, hydrocephalus, and preeclamptic pregnant patients. Additionally, it serves as an effective parameter for predicting neurological prognosis and mortality following cardiac arrest. Intraoperatively, serial ONSD measurements are preferred to reduce postoperative morbidity when monitoring ICP changes during craniosynostosis surgeries, ICP increases due to carbon dioxide release after tourniquet deflation in orthopedic surgery, and ICP elevations caused by carbon dioxide pneumoperitoneum and Trendelenburg positioning in laparoscopic surgery. Consequently, ONSD measurement offers a point-of-care, rapid, radiation-free, and safe bedside monitoring option.
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