Bang Yu Jeong, Jeong Heejoon, Heo Burn Young, Shin Byung Seop, Sim Woo Seog, Kim Duk-Kyung, Lee Sang Hyun, Kim Ji Su, Shin Young Hee
Samsung Medical Center, Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea.
Diagnostics (Basel). 2021 Dec 2;11(12):2260. doi: 10.3390/diagnostics11122260.
(1) Background: Robot-assisted laparoscopic prostatectomy (RALP) is preferred over open prostatectomy because it offers superior surgical outcomes and better postoperative recovery. The steep Trendelenburg position and pneumoperitoneum required in Robot-assisted laparoscopic prostatectomy, however, increase intracranial pressure (ICP). The present study aimed to evaluate the effects of elevated ICP on the quality of emergence from anesthesia. (2) Methods: Sixty-seven patients undergoing RALP were enrolled. We measured optic nerve sheath diameter at four timepoints during surgery. Primary outcome was inadequate emergence in the operating room (OR). Secondary outcomes were postoperative neurologic deficits of dizziness, headache, delirium, cognitive dysfunction, and postoperative nausea and vomiting (PONV). (3) Results: A total of 69 patients were screened for eligibility and 67 patients completed the study and were included in the final analysis. After establishing pneumoperitoneum with the Trendelenburg position, ONSD increased compared to baseline by 11.4%. Of the 67 patients, 36 patients showed an increase of 10% or more in optic nerve sheath diameter (ONSD). Patients with ΔONSD ≥ 10% experienced more inadequate emergence in the OR than those with ΔONSD < 10% (47.2% vs. 12.9%, = 0.003). However, other variables related to the quality of emergence from anesthesia did not different significantly between groups. Similarly, neurologic deficits, and PONV during postoperative day 3 showed no significant differences. (4) Conclusions: ICP elevation detected by ultrasonographic ONSD measurement was associated with a transient, inadequate emergence from anesthesia.
(1) 背景：机器人辅助腹腔镜前列腺切除术（RALP）优于开放性前列腺切除术，因为它能提供更好的手术效果和术后恢复。然而，机器人辅助腹腔镜前列腺切除术所需的陡峭头低脚高位和气腹会增加颅内压（ICP）。本研究旨在评估ICP升高对麻醉苏醒质量的影响。(2) 方法：纳入67例行RALP的患者。我们在手术过程中的四个时间点测量视神经鞘直径。主要结局是在手术室（OR）苏醒不足。次要结局是术后出现头晕、头痛、谵妄、认知功能障碍等神经功能缺损以及术后恶心呕吐（PONV）。(3) 结果：共筛选出69例符合条件的患者，67例患者完成研究并纳入最终分析。在头低脚高位建立气腹后，视神经鞘直径（ONSD）较基线增加了11.4%。67例患者中，36例患者的视神经鞘直径（ONSD）增加了10%或更多。ΔONSD≥10%的患者在手术室的苏醒不足情况比ΔONSD<10%的患者更多（47.2%对12.9%，P = 0.003）。然而，两组之间与麻醉苏醒质量相关的其他变量没有显著差异。同样，术后第3天的神经功能缺损和PONV也没有显著差异。(4) 结论：通过超声测量ONSD检测到的ICP升高与麻醉后短暂的苏醒不足有关。
