Optic Nerve Sheath Diameter Changes During Laparoscopic Cholecystectomy in the Reverse Trendelenburg Position: Total Intravenous Anesthesia vs. Desflurane

Objective: We aimed to compare the impacts of total intravenous anesthesia (TIVA) and desflurane on optic nerve sheath diameter (ONSD) among patients undergoing elective laparoscopic surgery in the reverse Trendelenburg position.
Material and Methods: In this prospective randomized trial, individuals aged 18 to 65 scheduled for laparoscopic cholecystectomy were recruited and randomly divided into either the TIVA or desflurane group. ONSD was assessed at four distinct time points: before anesthesia administration (T0), 5 min after carbon dioxide insufflation in the reverse Trendelenburg position (T1), 5 min after pneumoperitoneum termination in the reverse Trendelenburg position (T2), and post-extubation (T3). The primary outcome was the mean ONSD measurement at each of these time points within the TIVA and desflurane groups throughout the surgery.
Results: No statistical difference was found in the mean ONSD values between the groups at all four points. However, the mean change in ONSD between T0 and T1 points and T1 and T2 points was significantly lower in the TIVA group (p=0.025, p=0.006, respectively) than in the desflurane group.
Conclusion: Our findings imply that TIVA may be more appropriate for patients undergoing surgery in the reverse Trendelenburg position because of minor changes in ONSD.