Kaur Gagandeep, Sharma Mamta, Kalra Poonam, Purohit Shobha, Chauhan Kanchan
Department of Anaesthesia, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Anesth Essays Res. 2018 Jan-Mar;12(1):67-72. doi: 10.4103/aer.AER_177_17.
Intraocular pressure (IOP) is increased during laparoscopic surgery with Trendelenburg position and may contribute to deleterious effects on optic nerve in susceptible patients.
The primary objective of this study is to compare the effects of propofol-based total intravenous anesthesia (TIVA) with those of sevoflurane anesthesia on IOP in patients undergoing lower abdominal laparoscopic surgery in Trendelenburg position. Secondary objectives are to compare hemodynamic changes, mean arterial pressure (MAP), end-tidal CO, and peak inspiratory pressure changes.
Sixty patients with physical status American Society of Anesthesiologists classes I and II were randomly allocated in two groups: Group A (propofol) and Group B (sevoflurane). IOP along with other parameters was measured at seven points including baseline (T0), 5 min after induction (T1), 5 min after CO pneumoperitoneum in supine position (T2), 30 min after CO pneumoperitoneum with Trendelenburg position (T3), 5 min after returning to supine position (T4), 5 min after CO desufflation (T5), and 5 min after extubation (T6).
The change in IOP was different between the two groups. Maximum rise in IOP was seen at T3, and mean ± standard deviation IOP was 15.5 ± 0.9 mmHg and 19.8 ± 1.2 mmHg in Group A and Group B, respectively ( < 0.01). In Group A (propofol), IOP remained almost equal to the baseline value at T3 and the IOP difference was 0.3 ± 0.9 mmHg less than baseline (statistically insignificant, > 0.05), while in Group B (sevoflurane), IOP increased significantly at T3 and the difference was 4.0 ± 1.2 mmHg ( < 0.001). The IOP was significantly greater ( < 0.01) from T2 to T6 in sevoflurane group than propofol group.
Propofol-based TIVA is more effective than inhalational anesthesia with sevoflurane in attenuating the increase in IOP during laparoscopic surgery requiring CO pneumoperitoneum with Trendelenburg position.
在采用头低脚高位的腹腔镜手术过程中，眼内压（IOP）会升高，这可能会对易感患者的视神经产生有害影响。
本研究的主要目的是比较丙泊酚全静脉麻醉（TIVA）与七氟醚麻醉对处于头低脚高位的下腹部腹腔镜手术患者眼内压的影响。次要目的是比较血流动力学变化、平均动脉压（MAP）、呼气末二氧化碳分压及吸气峰压变化。
60例美国麻醉医师协会身体状况分级为I级和II级的患者被随机分为两组：A组（丙泊酚组）和B组（七氟醚组）。在包括基线（T0）、诱导后5分钟（T1）、仰卧位二氧化碳气腹后5分钟（T2）、头低脚高位二氧化碳气腹30分钟后（T3）、恢复仰卧位后5分钟（T4）、二氧化碳气腹放气后5分钟（T5）以及拔管后5分钟（T6）在内的7个时间点测量眼内压及其他参数。
两组患者眼内压变化不同。眼内压在T3时升高幅度最大，A组和B组的眼内压均值±标准差分别为15.5±0.9 mmHg和19.8±1.2 mmHg（P<0.01）。在A组（丙泊酚组），T3时眼内压几乎保持在基线值水平，眼内压差值比基线值低0.3±0.9 mmHg（无统计学意义，P>0.05），而在B组（七氟醚组），T3时眼内压显著升高，差值为4.0±1.2 mmHg（P<0.001）。七氟醚组从T2至T6的眼内压显著高于丙泊酚组（P<0.01）。
在需要采用头低脚高位二氧化碳气腹的腹腔镜手术中，基于丙泊酚的全静脉麻醉在减轻眼内压升高方面比七氟醚吸入麻醉更有效。
