This prospective observational study aims to evaluate the effect of internal jugular vein catheterization on intracranial pressure using optic nerve sheath diameter (ONSD) measurements and carotid artery Doppler ultrasonography in adult patients undergoing surgery under general anesthesia.
ONSD will be measured noninvasively using transorbital ultrasonography, and carotid Doppler parameters will be assessed at two time points: after endotracheal intubation and approximately 5 minutes after catheterization. The primary objective is to assess short-term changes in ONSD following catheterization.
Secondary objectives include evaluating changes in carotid Doppler measurements and their relationship with ONSD, as well as associations with physiological parameters such as blood pressure, heart rate, oxygen saturation, and end-tidal carbon dioxide.
Age ≥18 years
Patients undergoing surgery under general anesthesia
Patients requiring internal jugular vein catheterization as part of routine clinical care
Ability to obtain optic nerve sheath diameter measurements using transorbital ultrasonography
Known intracranial pathology affecting intracranial pressure
Ocular conditions preventing accurate ultrasonographic measurement (e.g., orbital trauma, ocular surgery, infection)
Hemodynamic instability
Contraindication to internal jugular vein catheterization
Adult patients undergoing surgical procedures under general anesthesia at a tertiary care hospital, in whom internal jugular vein catheterization is performed as part of routine clinical care.
Cohort
Prospective
Internal Jugular Vein Catheterization
Procedure/SurgeryInternal jugular vein catheterization is performed in patients undergoing major surgical procedures when clinically indicated as part of routine perioperative care. The procedure is not assigned by the study. Additional non-invasive ultrasound measurements, including optic nerve sheath diameter assessment, are obtained to evaluate physiological changes associated with catheterization without altering standard clinical management. Ultrasonography is a non-invasive and safe imaging method routinely used in clinical practice.
Change in Optic Nerve Sheath Diameter (mm) Following Internal Jugular Vein Catheterization
Optic nerve sheath diameter (ONSD) will be measured in millimeters using transorbital ultrasonography at 3 mm posterior to the optic disc on the side of catheterization. The outcome is defined as the difference between measurements obtained immediately after endotracheal intubation (baseline) and 5 minutes after internal jugular vein catheterization. Higher values indicate increased optic nerve sheath diameter.
Change in Internal Carotid Artery Peak Systolic Velocity (PSV) Following Internal Jugular Vein Catheterization
Peak systolic velocity (PSV) of the internal carotid artery will be measured in cm/s using Doppler ultrasonography. The outcome is defined as the difference between post-intubation (baseline) and post-catheterization values.
Change in Internal Carotid Artery End-Diastolic Velocity (EDV) Following Internal Jugular Vein Catheterization
End-diastolic velocity (EDV) of the internal carotid artery will be measured in cm/s using Doppler ultrasonography. The outcome is defined as the difference between post-intubation and post-catheterization values.
Change in Internal Carotid Artery Time-Averaged Maximum Velocity (TAMAX) Following Internal Jugular Vein Catheterization
Time-averaged maximum velocity (TAMAX) will be measured in cm/s using Doppler ultrasonography. The outcome is defined as the difference between post-intubation and post-catheterization values.
Change in Internal Carotid Artery Pulsatility Index (PI) Following Internal Jugular Vein Catheterization
Pulsatility index (PI) will be calculated from Doppler measurements (unitless). The outcome is defined as the difference between post-intubation and post-catheterization values.
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