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体位对腹腔镜妇科手术中眼内压的影响：一项随机临床试验。

The effect of anesthetic agents on intraocular pressure during laparoscopic gynecological surgery performed in the Trendelenburg position: A randomized clinical trial.

机构信息

Department of Anesthesiology and Reanimation, Health Science University, Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Turkey.

Department of Ophthalmology, Health Science University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul-Turkey.

出版信息

Ulus Travma Acil Cerrahi Derg. 2022 Apr;28(4):498-507. doi: 10.14744/tjtes.2020.56019.

DOI:10.14744/tjtes.2020.56019
PMID:35485512
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10443124/
Abstract

BACKGROUND

Intraocular pressure (IOP) increases due to pneumoperitoneum and the Trendelenburg position during laparo-scopic surgery. Apart from ketamine and suxamethonium, anesthetic agents generally reduce IOP by various extents. The present study investigated the effects of combinations of four anesthetic agents on IOP during laparoscopic gynecological surgery.

METHODS

Patients (n=100) were assigned to one of the four groups: Group 1 (n=25; pentothal induction + desflurane/remifen-tanil maintenance), Group 2 (n=25; propofol induction + sevoflurane/remifentanil maintenance), Group 3 (n=25; propofol induction + desflurane/remifentanil maintenance), and Group 4 (n=25; pentothal induction + sevoflurane/remifentanil maintenance). The IOPs recorded before anesthesia induction, after intubation, after carbon dioxide insufflation, in the Trendelenburg position, and after ex-tubation were compared among the groups. Hemodynamic parameters were also evaluated.

RESULTS

Induction in Group 2 and Group 3 used propofol. When the IOP in the Trendelenburg position was compared with the IOP before induction, there was no statistically significant difference in Groups 2 and 3 (p>0.05). In Groups 1 and 4, pentothal was used for induction. The IOP in Groups 1 and 4 was statistically significantly higher in the Trendelenburg position than it was before induction (0.027-0.001).

CONCLUSION

To minimize the variation in IOP in the Trendelenburg position during laparoscopic gynecological surgeries, we recommend the use of propofol for induction, independent of desflurane or sevoflurane use.

摘要

背景

在腹腔镜手术中，由于气腹和头低位，眼内压（IOP）升高。除了氯胺酮和琥珀胆碱外，麻醉剂通常会在不同程度上降低 IOP。本研究旨在探讨四种麻醉剂组合在腹腔镜妇科手术中对 IOP 的影响。

方法

将 100 例患者分为四组：组 1（n=25；依托咪酯诱导+地氟烷/瑞芬太尼维持）、组 2（n=25；异丙酚诱导+七氟醚/瑞芬太尼维持）、组 3（n=25；异丙酚诱导+地氟烷/瑞芬太尼维持）和组 4（n=25；依托咪酯诱导+七氟醚/瑞芬太尼维持）。比较各组患者麻醉诱导前、插管后、二氧化碳充气后、头低位和拔管后 IOP，评估血流动力学参数。

结果

组 2 和组 3 诱导时使用异丙酚。与诱导前相比，头低位时组 2 和组 3 的 IOP 无统计学差异（p>0.05）。组 1 和组 4 诱导时使用依托咪酯。与诱导前相比，组 1 和组 4 头低位时 IOP 显著升高（0.027-0.001）。

结论

为了最大限度地减少腹腔镜妇科手术中头低位时 IOP 的变化，我们建议使用异丙酚诱导，无论使用地氟烷还是七氟醚。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5413/10443124/7b2ea396d6ff/TJTES-28-498-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5413/10443124/51bb887a2118/TJTES-28-498-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5413/10443124/7b2ea396d6ff/TJTES-28-498-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5413/10443124/51bb887a2118/TJTES-28-498-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5413/10443124/7b2ea396d6ff/TJTES-28-498-g002.jpg

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