Previous article Table of Contents  Next article

LETTERS TO EDITOR
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 139-140

Comment on article 'Fixed dilated pupils following laparoscopic urological procedure: Steep trendelenburg position was the cause'


Department of Neurosciences, Sri Mata Vaishno Devi Narayana Hospital, Kakryal, Jammu Kashmir, India

Correspondence Address:
Summit Dev Bloria
326/c Sainik Colony, Jammu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_717_21

Rights and Permissions
Date of Submission07-Oct-2021
Date of Acceptance08-Oct-2021
Date of Web Publication04-Jan-2022
 


How to cite this article:
Bloria SD. Comment on article 'Fixed dilated pupils following laparoscopic urological procedure: Steep trendelenburg position was the cause'. Saudi J Anaesth 2022;16:139-40

How to cite this URL:
Bloria SD. Comment on article 'Fixed dilated pupils following laparoscopic urological procedure: Steep trendelenburg position was the cause'. Saudi J Anaesth [serial online] 2022 [cited 2022 Jan 19];16:139-40. Available from: https://www.saudija.org/text.asp?2022/16/1/139/334773



I read with interest the article by Kumari et al.[1] The authors describe successful management of a major intraoperative complication. Indeed, prolonged head-down position intraoperatively can predispose to an increase in intracranial pressure (ICP). However, when using optic nerve sheath diameter (ONSD) to detect raised ICP, the authors missed subtle tricks of the trade. ONSD is usually measured 3 mm behind the origin of the optic nerve as that is considered the most distensible part of the optic nerve sheath.[2] The figure accompanying the said article does not make any mention of the distance behind the origin of the optic nerve where the ONSD measurement was taken, but it is more than 3 mm as can be gauged by the distance between the calipers used in the measurement of ONSD. Obtaining a satisfactory image for ONSD measurement is imperative for proper utilization of ONSD as a tool to detect raised ICP. There have been suggestions regarding the sonographic quality criteria for optimizing ONSD measurements.[3] Also, the authors did not utilize ONSD measurement after mannitol administration. A reduction in ONSD after mannitol administration would have strengthened their claim that it was raised ICP only which caused delayed awakening and not residual sedation and paralysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumari P, Deepshikha, Kumar A, Kumar R, Kumar A, Surabhi. Fixed dilated pupils following laparoscopic urological procedure: Steep trendelenburg position was the cause. Saudi J Anaesth 2021;15;469-71.  Back to cited text no. 1
    
2.
Bloria SD, Bloria P, Luthra A. Is it the time to standardize the procedure of ultrasound guided optic nerve sheath diameter measurement?. Saudi J Anaesth 2019;13:255-6.  Back to cited text no. 2
    
3.
Sargsyan AE, Blaivas M, Geeraerts T, Karakitsos D. Ocular ultrasound in the intensive care unit. In: Lumb P, Karakitsos D, editors. Critical Care Ultrasound. 1st ed. Philadelphia, PA, USA: Elsevier Saunders; 2014. ISBN:9781455753574.  Back to cited text no. 3
    




 

Top
 
Previous article    Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   References

 Article Access Statistics
    Viewed648    
    Printed0    
    Emailed0    
    PDF Downloaded21    
    Comments [Add]    

Recommend this journal