Chang Chun-Yu, Chien Yung-Jiun, Wu Meng-Yu
School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
Department of Physical Medicine and Rehabilitation, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan.
J Adv Res. 2020 Feb 13;24:223-238. doi: 10.1016/j.jare.2020.02.008. eCollection 2020 Jul.
Attenuation of an increase in intraocular pressure (IOP) is crucial to preventing devastating postoperative visual loss following surgery. IOP is affected by several factors, including the physiologic alteration due to pneumoperitoneum and patient positioning and differences in anesthetic regimens. This study aimed to investigate the effects of propofol-based total intravenous anesthesia (TIVA) and volatile anesthesia on IOP. We searched multiple databases for relevant studies published before October 2019. Randomized controlled trials comparing the effects of propofol-based TIVA and volatile anesthesia on IOP during surgery were considered eligible for inclusion. Twenty studies comprising 980 patients were included. The mean IOP was significantly lower in the propofol-based TIVA group after intubation, pneumoperitoneum, Trendelenburg positioning, and lateral decubitus positioning. Moreover, mean arterial pressure and peak inspiratory pressure were also lower after intubation in the propofol-based TIVA group. Trial sequential analyses for these outcomes were conclusive. Propofol-based TIVA is more effective than volatile anesthesia during surgery at attenuating the elevation of IOP and should be considered, especially in at-risk patients.
降低眼内压（IOP）升高对于预防手术后严重的视力丧失至关重要。眼内压受多种因素影响，包括气腹和患者体位引起的生理改变以及麻醉方案的差异。本研究旨在探讨丙泊酚全静脉麻醉（TIVA）和挥发性麻醉对眼内压的影响。我们检索了多个数据库，查找2019年10月之前发表的相关研究。比较丙泊酚TIVA和挥发性麻醉在手术期间对眼内压影响的随机对照试验被认为符合纳入标准。纳入了20项研究，共980例患者。在插管、气腹、头低脚高位和侧卧位后，丙泊酚TIVA组的平均眼内压显著更低。此外，丙泊酚TIVA组插管后的平均动脉压和吸气峰压也更低。对这些结果的试验序贯分析具有决定性意义。在手术期间，丙泊酚TIVA在减轻眼内压升高方面比挥发性麻醉更有效，应予以考虑，尤其是对于高危患者。
