经口机器人甲状腺切除术中使用视神经鞘直径测量法检测颅内压升高

Detection of increased intracranial pressure in trans-oral robotic thyroidectomy using optic nerve sheath diameter measurement.

作者信息

Lim Hyunyoung, Kim Eugene, Kim Soo Yeon, Kim Ji-Yoon, Jung Yundo, Lee Tagkeun, Kim Nayeon, Tae Kyung

机构信息

Department of Anesthesiology and Pain Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea.

Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Seoul, Republic of Korea.

出版信息

Head Neck. 2023 Feb;45(2):329-336. doi: 10.1002/hed.27234. Epub 2022 Nov 5.

DOI:10.1002/hed.27234

PMID:36333967

Abstract

BACKGROUND

During transoral robot-assisted thyroidectomy, there is a risk of increasing intracranial pressure because the site of CO insufflation is narrow and close to the brain.

METHODS

We analyzed the pre- to post-CO neck insufflation change in the optic nerve sheath diameter during transoral robot-assisted thyroidectomy. Changes in vital-signs, airway pressure, and arterial carbon dioxide pressure were analyzed along with postoperative complications.

RESULTS

Among the 30 participants, the post-CO inflation mean optic nerve sheath diameter (5.64 ± 0.54 mm) was higher than the pre-induction diameter (4.81 ± 0.37 mm) with a mean difference of 0.83 (95% CI, 0.69-0.97; p < 0.001), but returned to baseline after CO deflation in most cases. One participant had sustained increased optic nerve sheath diameter (6.35 mm) associated with severe new-onset postoperative headache.

CONCLUSION

Transient elevation in the intracranial pressure during low-pressure CO neck insufflation in the transoral robot-assisted thyroidectomy did not appear to adversely affect patients.

摘要

背景

在经口机器人辅助甲状腺切除术中，由于二氧化碳（CO）气腹部位狭窄且靠近脑部，存在颅内压升高的风险。

方法

我们分析了经口机器人辅助甲状腺切除术中CO气腹前后视神经鞘直径的变化。同时分析了生命体征、气道压力和动脉二氧化碳分压的变化以及术后并发症。

结果

在30名参与者中，CO充气后视神经鞘平均直径（5.64±0.54mm）高于诱导前直径（4.81±0.37mm），平均差值为0.83（95%可信区间，0.69 - 0.97；p<0.001），但在大多数情况下，CO放气后恢复至基线水平。一名参与者的视神经鞘直径持续增加（6.35mm），并伴有严重的新发术后头痛。