Research In Application Of Ultrasound Measurement Of Optic Nerve Sheath Diameter In Surgery With Self-retaining Laryngoscope

Objective:Comparing ultrasonography of the optic nerve sheath diameter(ONSD)in patients undergoing surgery with a self-retaining laryngoscope under general anesthesia at different time points to estimate the influence of self-retaining laryngoscope on intracranial pressure(ICP)during operation and postoperative nausea and vomiting(PONV),so as to provide reference of cerebral protective for patients undergoing such surgery.Methods:Forty patients undergoing elective surgery with a self-retaining laryngoscope were selected.Ultrasonography was used to record ONSD values for all patients before anesthesia induction(T0)、immediately after tracheal intubation(T1)、10min after tracheal intubation(T2)、immediately after self-retaining laryngoscope insertion(T3)、before removal of the self-retaining laryngoscope at the end of surgery(T4)and 10min after removal of the selfretaining laryngoscope(T5).The ONSD values and vital signs were recorded at each measuring point.The number and level of postoperative nausea and vomiting were also recorded.Results:1.There were statistically significant differences in ONSD values at different time points(P<0.001).Comparing with T0,the ONSD values at T1、T3、T4 were significantly increased(P<0.001),the increasing rate of ONSD values were 14.48%、16.05%、14.37%,respectively.2.There were no significant differences in MAP、HR、ETCO2、PPEAK、BIS and Temperature at different time points(P>0.05).3.Incidence of postoperative nausea and vomiting with a self-retaining laryngoscope surgery was 32.5%.Sulfentanil dosage、the duration of self-retaining laryngoscope and the increasing rate of ONSD value at T3 were independent risk factors of PONV(OR=1.582,P=0.046;OR=1.517,P=0.025;OR=1.497,P=0.017).4.ROC curve analysis showed that an area under the curve of the increasing rate of ONSD value in predicting the risk of postoperative nausea and vomiting was 0.883(95%CI:0.778-0.989,P<0.001)with a cutoff value of 15.21%.The pooled sensitivity and specificity were 0.923 and 0.778,respectively.Conclusions:The use of a self-retaining laryngoscope can significantly increase ONSD values in surgical patients.The change of ONSD value will enhance incidence of PONV.