Clin Transplant Res.  2024 Jun;38(2):106-115. 10.4285/ctr.24.0007.

Perioperative optic nerve sheath diameter variations in patients with end-stage renal failure undergoing robotic-assisted kidney transplant: a prospective observational study

• Rajmohan N
• Thiruvathtra J
• Omkarappa S
• Srinivasan SP
• Eldo N
• Rajgopal R

• KMID: 2557604
• DOI: http://doi.org/10.4285/ctr.24.0007

Abstract

Background
Patients with chronic kidney disease (CKD) who undergo hemodialysis are predisposed to interstitial cerebral edema. Robotic-assisted laparoscopic surgery can increase optic nerve sheath diameter (ONSD) and intracranial pressure. The impact of robotic-assisted kidney transplant (RAKT) on ONSD is complicated by the presence of CKD, the administration of furosemide and mannitol, and the manipulation of hemodynamics. We examined ONSD variations in patients undergoing RAKT over a 1-year period at our institution. Furthermore, we attempted to identify any perioperative hemodynamic factors influencing these changes.
Methods
This prospective study included 20 patients undergoing RAKT. ONSD, heart rate, central venous pressure, systolic blood pressure, diastolic blood pressure (DBP), and mean arterial pressure (MAP) were measured following intubation (T1), after assuming the steep Trendelenburg position (T2), 1 hour after docking (T3), upon reperfusion (T4), after transition to the supine position (T5), and 3 hours postextubation (T6). Repeated measures analysis of variance with post hoc Bonferroni correction was employed to compare variables at each time point. Pearson correlation analysis was utilized to assess relationships between variables. P-values ≤0.05 were considered to indicate statistical significance.
Results
ONSD (in mm) increased from T1 (3.60±0.44) to T3 (4.06±0.45, P=0.002) and T4 (3.99±0.62, P=0.046), before falling to its lowest value at T6 (3.42±0.64, P=0.002). Pearson correlation analysis revealed significant correlations (P<0.05) between changes in ONSD at T3 and both DBP (r=0.637) and MAP (r=0.522).
Conclusions
During RAKT with open ureteric anastomosis, ONSD initially increased, then decreased following reperfusion. DBP and MAP displayed positive correlations with ONSD changes at T3.

Keyword

Elevated intracranial pressure; Kidney transplantations; Pneumoperitoneum; Robotic-assisted surgery; Trendelenburg position

Figure

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  Fig. 1 Ultrasonographic measurement of the optic nerve sheath diameter (ONSD). The ONSD (B) was measured 3 mm behind the optic nerve (A).

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  Fig. 2 Associated comorbidities. 0, no comorbidities; 1, hypertension; 2, diabetes; 3, coronary arterial disease; 4, dyslipidemia; 5, moderate pulmonary artery hypertension; 6, smoking; 7, hepatitis C; 8, valvular heart disease.

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  Fig. 3 Optic nerve sheath diameter (ONSD) variation at predetermined time points. T1, 10 minutes after intubation; T2, upon assuming the steep Trendelenburg position after docking; T3, 1 hour postdocking; T4, upon reperfusion; T5, after transition to the supine position; T6, 3 hours postextubation.

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  Fig. 4 Changes in hemodynamic parameters. HR, heart rate; DBP, diastolic blood pressure; MAP, mean arterial pressure; SBP, systolic blood pressure; T1, 10 minutes after intubation; T2, upon assuming the steep Trendelenburg position after docking; T3, 1 hour postdocking; T4, upon reperfusion; T5, after transition to the supine position; T6, 3 hours postextubation.

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