Does a change in optic nerve sheath diameter have an association with postoperative emergence delirium in paediatric patients undergoing laparoscopic surgeries? : An observational study

In the laparoscopic surgeries, the carboperitoneum created causes an increase in the intracranial pressure. Optic nerve sheath diameter measurement is a simple bedside tool which can be used as a surrogate for an increased intracranial pressure. There are studies in adult population showing the correlation between

increased optic nerve sheath diameter intraoperatively and inadequate postoperative awakening; but no such studies exist in paediatric population.

PRIMARY OBJECTIVE:

To determine the association between the intraoperative change in optic nerve sheath diameter (ONSD) and postoperative emergence delirium in paediatric patients undergoing laparoscopic surgeries

SECONDARY OBJECTIVES:

To correlate ONSD with postoperative emergence delirium score in patients with postoperative emergence delirium.To correlate ONSD with postoperative nausea vomiting and to correlate postoperative emergence delirium with preoperative patient anxiety

Sample size: 103 patients

Inclusion criteria

1. Age 2 to 8 years

2. ASA physical status I/II

3. Patients undergoing various laparoscopic surgeries under general anaesthesia

4. Cognitively intact children

Exclusion criteria

1. Parental /guardian refusal for inclusion in the study

2. Patients with age < 2 years and >8 years

3. History of eye surgery

4. Current eyeball/orbit disease (e.g., cataract, glaucoma, retinal detachment)

5. Increased intracranial pressure (e.g., brain tumour, spinal cord lesion)

6. Seizure disorder, developmental disorder, psychiatric illness

7. History of adverse reaction to ultrasound gel or Tegaderm

8. ASA grade III/IV

On arrival of the patient to the operating room,  standard ASA monitoring will be employed.  General anaesthesia will be given to the patient. Ultrasonographic Measurement of Optic Nerve Sheath Diameter will be measured at three specific timepoints. T1, immediately after the induction of anaesthesia; T2, 15 minutes after intraperitoneal CO2 insufflation and T3, 10 min after releasing the pneumoperitoneum. In the PACU, the ED will be assessed on arrival to PACU and at each 5-minute interval till 30 minutes from the time of awakening and whenever the child becomes agitated. Postoperative nausea and vomiting will be assessed on a 4 point objective score till 3o minutes after the surgery.  The modified Yale preoperative anxiety scale will be used to assess preoperative anxiety in the preoperative holding area 30 minutes prior to surgery.

We hypothesize that in paediatric patients undergoing laparoscopic surgeries an intraoperative change of optic nerve sheath diameter will have an association with postoperative emergence delirium.