VIMA vs TIVA and ONSD in Laparoscopic Cholecystectomy

This prospective, single‐center, randomized, open‐label study compared total intravenousanesthesia (TIVA) with volatile induction and maintenance anesthesia (VIMA) in adultpatients undergoing elective laparoscopic cholecystectomy. The primary objective was toevaluate whether the anesthetic technique influenced perioperative changes in optic nervesheath diameter (ONSD), a noninvasive ultrasonographic surrogate marker of intracranialpressure.ONSD was measured from the right eye using a 12‐MHz linear ultrasound probe at sixpredefined perioperative time points: before induction, after tracheal intubation, afterpneumoperitoneum, after reverse Trendelenburg positioning, 30 minutes after intubation,and after desufflation. Six consecutive measurements were obtained at each time point andaveraged. Pneumoperitoneum pressure was maintained at 12 mmHg, reverse Trendelenburgpositioning was 15°‐30°, and anesthetic depth was guided by Bispectral Index monitoring.Secondary assessments included intraoperative hemodynamic and respiratory variables,postoperative pain, nausea, vomiting, headache, diplopia, recovery time, and anestheticdrug cost. The final analysis was performed on the evaluable per‐protocol population.