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Effect of Tonsillar Retractor on Intracranial and Intraocular Pressure in Children Undergoing Adenotonsillectomy

Ayse Bozkurt Oflaz1, Meltem Isık2, Merih Onal3

  • 1Department of Ophthalmology Selcuk University Konya Turkey.

Laryngoscope Investigative Otolaryngology
|July 10, 2026
PubMed

Insights

Tonsillar retractor use during pediatric adenotonsillectomy significantly increases intracranial pressure (ICP) and intraocular pressure (IOP). Surgeons and anesthesiologists should consider these rapid pressure surges in at-risk children.

Area of Science:

  • Pediatric Surgery
  • Anesthesiology
  • Ophthalmology

Background:

  • Adenotonsillectomy is a common pediatric surgery.
  • Tonsillar retractor use may elevate sympathetic activity.
  • The impact of tonsillar retractors on intracranial and intraocular pressure is not well-understood.

Purpose of the Study:

  • To evaluate the effect of tonsillar retractor insertion on intracranial pressure (ICP) and intraocular pressure (IOP).
  • To assess hemodynamic changes associated with tonsillar retractor use in pediatric adenotonsillectomy.

Main Methods:

  • Prospective observational study of 24 pediatric patients undergoing adenotonsillectomy.
  • Measurement of optic nerve sheath diameter (ONSD) via ultrasonography to estimate ICP.
  • Intraocular pressure (IOP) assessed by tonometry; hemodynamic parameters recorded.
  • Comparison with 20 age-matched controls undergoing other surgeries.

Main Results:

  • Tonsillar retractor insertion significantly increased mean ONSD (ICP proxy) and IOP.
  • Mean ONSD increased from 4.66 to 5.61 mm (p < 0.001).
  • Mean IOP rose from 13.7 to 18.2 mmHg (p < 0.001).
  • Systolic blood pressure increased, but diastolic pressure changes were not significant.
  • No significant correlation found between ONSD and IOP changes.

Conclusions:

  • Tonsillar retractor use during adenotonsillectomy causes a rapid and significant rise in ICP and IOP.
  • These findings are crucial for otolaryngologists and anesthesiologists managing pediatric patients.
  • Consideration of these pressure surges is recommended for patients at risk of sympathetic surges.
Abstract

Keywords:
adenotonsillectomychildrencomplicationintraocular pressureoptic nerve sheath diametertonsillar retractor

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