LETTERS TO EDITOR
Year : 2022 | Volume
| Issue : 1 | Page : 139-140
Comment on article 'Fixed dilated pupils following laparoscopic urological procedure: Steep trendelenburg position was the cause'
Summit Dev Bloria
Department of Neurosciences, Sri Mata Vaishno Devi Narayana Hospital, Kakryal, Jammu Kashmir, India
Summit Dev Bloria
326/c Sainik Colony, Jammu
Source of Support: None, Conflict of Interest: None
|Date of Submission||07-Oct-2021|
|Date of Acceptance||08-Oct-2021|
|Date of Web Publication||04-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. 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. 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. 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.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
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.
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.