1 Department of Anesthesiology and Pain Medicine, Kangnam Sacred Heart Hospital, University of Hallym College of Medicine , Seoul, Korea.
2 Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
J Endourol. 2018 Jul;32(7):608-613. doi: 10.1089/end.2017.0828. Epub 2018 Mar 13.
CO pneumoperitoneum and the steep Trendelenburg position during robot-assisted laparoscopic prostatectomy (RALP) can increase intracranial pressure (ICP). Mannitol is widely used to treat increased ICP. However, no studies to date have specifically evaluated the effect of mannitol on ICP in patients undergoing RALP. Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is considered a reliable technique to noninvasively evaluate the ICP. Therefore, this study compared ONSDs as a surrogate for ICP before and after mannitol administration in prostate cancer patients undergoing RALP.
Mannitol (0.5 g/kg) was administered after pneumoperitoneum establishment and shifting to the Trendelenburg position. ONSDs were measured at six predetermined time points: 10 minutes after anesthesia induction (T0); 5 minutes after pneumoperitoneum and the Trendelenburg position before mannitol administration (T1); 30 minutes (T2), 60 minutes (T3), and 90 minutes (T4) after completion of mannitol administration during pneumoperitoneum and the Trendelenburg position; and at skin closure in the supine position (T5). Moreover, intraoperative hemodynamic and respiratory variables were evaluated simultaneously.
Thirty-six patients were analyzed. ONSDs were significantly lower at T2, T3, and T4 than at T1 (all p < 0.001), with the greatest decrease observed at T4 compared with T1 (4.46 ± 0.2 mm vs 4.81 ± 0.3 mm, p < 0.001). Regional cerebral oxygen saturation, cardiac output, corrected flow time, peak velocity, body temperature, arterial CO partial pressure, peak airway pressure, plateau airway pressure, dynamic compliance, and static compliance were not significantly different during pneumoperitoneum and the Trendelenburg position; however, mean arterial blood pressure and heart rate were significantly different.
Mannitol decreases the ONSD in patients undergoing RALP with CO pneumoperitoneum and the steep Trendelenburg position. This result provides useful information on the beneficial effects of mannitol administration on prostate cancer patients who may develop increased ICP during RALP.
在机器人辅助腹腔镜前列腺切除术（RALP）中，CO 气腹和头高脚低位会增加颅内压（ICP）。甘露醇被广泛用于治疗 ICP 升高。然而，迄今为止尚无研究专门评估甘露醇对 RALP 患者 ICP 的影响。视神经鞘直径（ONSD）的超声测量被认为是一种可靠的技术，可无创评估 ICP。因此，本研究比较了 RALP 患者在接受甘露醇治疗前后 ONSD 作为 ICP 的替代指标。
在建立气腹并转为头高脚低位后给予甘露醇（0.5 g/kg）。在六个预定的时间点测量 ONSD：麻醉诱导后 10 分钟（T0）；气腹和头高脚低位前 5 分钟（T1）；甘露醇给药后 30 分钟（T2）、60 分钟（T3）和 90 分钟（T4）；以及在气腹和头高脚低位下皮肤缝合时（T5）。此外，同时评估术中血流动力学和呼吸变量。
分析了 36 例患者。T2、T3 和 T4 时 ONSD 明显低于 T1（均 p<0.001），T4 时 ONSD 与 T1 相比下降最大（4.46±0.2mm 比 4.81±0.3mm，p<0.001）。在气腹和头高脚低位期间，局部脑氧饱和度、心输出量、校正流量时间、峰值速度、体温、动脉 CO 分压、气道峰压、平台气道压、动态顺应性和静态顺应性无显著差异；然而，平均动脉血压和心率有显著差异。
在接受 CO 气腹和头高脚低位的 RALP 患者中，甘露醇会降低 ONSD。这一结果为 RALP 期间可能发生 ICP 升高的前列腺癌患者使用甘露醇治疗的有益效果提供了有用信息。
