Department of Anesthesia, Obstetrics and Gynecology Hospital of Fudan University, No.128, Shenyang RD, Yangpu district, Shanghai, 200090, China.
Department of Emergency and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Anesthesiol. 2021 Jan 27;21(1):30. doi: 10.1186/s12871-021-01243-7.
The results of studies on changes in intracranial pressure in patients undergoing laparoscopic surgery are inconsistent. Meanwhile, previous neurosurgery studies have suggested that propofol and sevoflurane have inconsistent effects on cerebral blood flow and cerebrovascular self-regulation. The purpose of this study is to compare changes in the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery under anesthetic maintenance with propofol versus sevoflurane.
This study included 110 patients undergoing laparoscopic gynecological surgery with an estimated operative time of more than 2 h under general anesthesia. The study was a randomized controlled study. The optic nerve sheath diameter (ONSD) at various time points was measured by ultrasound, including when the patients entered the operating room (Tawake), after successful anesthesia induction and endotracheal intubation (Tinduction), when the body position was adjusted to the Trendelenburg position and the CO pneumoperitoneum pressure reached 14 mmHg, which was recorded as T. Then, measurements were conducted every 15 min for the first 1 h and then once every hour until the end of the surgery (T, T, T, T, T …), after the end of surgery and the tracheal tube was removed (T), and before the patients were transferred to the ward (T).
A significant difference in optic nerve sheath diameter was found between two groups at T, T, T (4.64 ± 0.48 mm and 4.50 ± 0.29 mm, respectively, p = 0.031;4.77 ± 0.45 mm and 4.62 ± 0.28 mm, respectively, p = 0.036;4.84 ± 0.46 mm and 4.65 ± 0.30 mm, respectively, p = 0.012), while there was no significant difference at T and other time points.
During laparoscopic gynecological surgery lasting more than 2 h, the optic nerve sheath diameter was slightly larger in the propofol group than that in the sevoflurane group in the first 45 min. No significant difference was observed between the two groups 1 h after surgery.
clinicaltrials.gov, NCT03498235 . Retrospectively registered 1 March 2018. The manuscript adheres to CONSORT guidelines.
腹腔镜手术患者颅内压变化的研究结果不一致。同时，先前的神经外科研究表明，丙泊酚和七氟醚对脑血流和脑血管自身调节的影响不一致。本研究旨在比较腹腔镜妇科手术中以丙泊酚和七氟醚维持麻醉患者视神经鞘直径的变化。
本研究纳入了 110 例行全身麻醉下腹腔镜妇科手术且预计手术时间超过 2 小时的患者。该研究为随机对照研究。通过超声测量患者进入手术室（Tawake）、成功麻醉诱导和气管插管（Tinduction）、体位调整至Trendelenburg 位且 CO 气腹压力达到 14mmHg 时（T）、15min 后测量第一次 1h 内的视神经鞘直径（ONSD），然后每隔 1h 测量一次，直至手术结束（T、T、T、T、T……）、手术结束后气管导管拔除（T）和患者转至病房前（T）。
两组患者在 T、T、T 时视神经鞘直径存在显著差异（分别为 4.64±0.48mm 和 4.50±0.29mm，p=0.031；4.77±0.45mm 和 4.62±0.28mm，p=0.036；4.84±0.46mm 和 4.65±0.30mm，p=0.012），而 T 和其他时间点无显著差异。
在持续 2 小时以上的腹腔镜妇科手术中，前 45 分钟内，丙泊酚组患者的视神经鞘直径略大于七氟醚组。术后 1 小时，两组间无显著差异。
clinicaltrials.gov，NCT03498235。于 2018 年 3 月 1 日进行回顾性注册。本手稿符合 CONSORT 指南。
