Department of Anesthesia and Pain Medicine, National Cancer Center, Gyeonggi-do, Republic of Korea.
Biostatistics Collaboration Team, Research Core Center, Research Institute, National Cancer Center, Gyeonggi-do, Republic of Korea.
Biomed Res Int. 2019 Dec 14;2019:5617815. doi: 10.1155/2019/5617815. eCollection 2019.
Robot-assisted laparoscopic radical prostatectomy (RLRP) can increase intracranial pressure (ICP) related to a change in position. Increasing ICP may result in various ocular complications, which are rare but serious, such as a corneal abrasion and ischemic optic neuropathy. We performed a prospective observational trial using ultrasonographic measurements to compare optic nerve sheath diameter (ONSD) related to ICP between patients who received either propofol or sevoflurane and underwent RLRP.
Thirty-two male patients scheduled to undergo RLRP were assigned into groups according to the anesthetic agent used (group P: propofol, = 16; group S: sevoflurane, = 16). ONSD, end-tidal partial pressure of CO, and blood pressure were measured 10 min after induction of anesthesia (T0), 30 min (T1), 60 min (T2), and 90 min after changing to the steep Trendelenburg position and introducing a pneumoperitoneum (T3) and 10 min after returning the patient's position to supine (T4) during surgery.
No significant differences were observed in the demographic data of the patients, surgery time, or intraoperative variables, including hemodynamic and respiratory variables, at any of the time points. The mean right ONSDs in the propofol and sevoflurane groups were 37.3 and 40.1 mm at 30 min (=0.003), respectively. The mean left ONSDs were 38.4 and 40.8 mm at 30 min (=0.021) after changing to the Trendelenburg position. The ONSDs between the two groups were significantly different during surgery.
ONSD increased more in the sevoflurane group than in the propofol group during RLRP. Intravenous anesthetics could alleviate the increase in ICP during RLRP.
机器人辅助腹腔镜根治性前列腺切除术（RLRP）可引起颅内压（ICP）相关的体位改变。ICP 升高可能导致各种眼部并发症，这些并发症虽然罕见但很严重，如角膜擦伤和缺血性视神经病变。我们进行了一项前瞻性观察性试验，使用超声测量来比较接受丙泊酚或七氟醚麻醉并接受 RLRP 的患者的视神经鞘直径（ONSD）与 ICP 的关系。
32 名男性患者按麻醉药物分为两组（P 组：丙泊酚，n=16；S 组：七氟醚，n=16）。在麻醉诱导后 10 分钟（T0）、30 分钟（T1）、60 分钟（T2）和改变为头高脚低位并建立气腹后 90 分钟（T3）以及手术中患者回到仰卧位后 10 分钟（T4）测量 ONSD、呼气末二氧化碳分压和血压。
在任何时间点，两组患者的人口统计学数据、手术时间或术中变量（包括血流动力学和呼吸变量）均无显著差异。丙泊酚和七氟醚组的右侧 ONSD 在 30 分钟时分别为 37.3 和 40.1mm（=0.003）。改为头高脚低位后，左侧 ONSD 分别为 38.4 和 40.8mm（=0.021）。两组间手术期间的 ONSD 差异有统计学意义。
在 RLRP 中，七氟醚组的 ONSD 增加多于丙泊酚组。静脉麻醉可减轻 RLRP 期间 ICP 的升高。
