小儿尾部注射容量对视神经鞘直径和局部脑氧饱和度的影响：一项随机试验。

Effect of paediatric caudal injection volume on optic nerve sheath diameter and regional cerebral oximetry: A randomised trial.

机构信息

From the Department of Anaesthesiology and Intensive Care (AOG, GK, AÇT, PK) and Department of Paediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Fatih/İstanbul, Türkiye (RÖ, SE).

出版信息

Eur J Anaesthesiol. 2023 Jul 1;40(7):465-471. doi: 10.1097/EJA.0000000000001819. Epub 2023 Mar 20.

DOI:10.1097/EJA.0000000000001819

PMID:36938985

Abstract

BACKGROUND

Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO 2 ) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure.

OBJECTIVES

Comparing how caudal injection volumes of 0.8 and 1.25 ml kg -1 influence ONSD and CrSO 2 within the first 30 min after injection.

DESIGN

Prospective, randomised and parallel group trial.

SETTING

Operating room.

PATIENTS

Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single - shot caudal anaesthesia.

INTERVENTION

Single-shot caudal anaesthesia with 0.8 ml kg -1 (group L, n = 29) and 1.25 ml kg -1 (group H, n = 29) of 2 mg kg -1 bupivacaine solution.

MAIN OUTCOME MEASURES

Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near - infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block.

RESULTS

Mean ONSD values increased from a baseline of 4.4 ± 0.2 mm to a maximum of 4.5 ± 0.2 mm 20 min after injection in group L and from a baseline of 4.5 ± 0.3 mm to a maximum of 4.8 ± 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO 2 .

CONCLUSION

Caudal injection with 1.25 ml kg -1 increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg -1 and neither volume caused a clinically important reduction in CrSO 2 .

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04491032.

摘要

背景

在儿童的椎管内麻醉中，常使用骶管注射来阻滞，可能会导致脑脊液向颅侧移位，从而引发颅内压升高的安全隐患。视神经鞘直径（ONSD）是一种测量颅内压的非侵入性替代方法。区域性脑组织氧饱和度（CrSO 2 ）可以监测脑氧合，由于颅内压升高导致脑血流减少，CrSO 2 可能会降低。

目的

比较 0.8ml/kg-1 和 1.25ml/kg-1 的骶管注射剂量在注射后 30 分钟内对 ONSD 和 CrSO 2 的影响。

设计

前瞻性、随机、平行组试验。

地点

手术室。

患者

58 例择期行小儿外科手术的患者，年龄 1 至 7 岁，ASA 分级 I 或 II 级，无颅内或眼部疾病史，适合单次骶管麻醉。

干预措施

单次骶管麻醉，给予 2mg/kg-1 的布比卡因溶液 0.8ml/kg-1（L 组，n=29）和 1.25ml/kg-1（H 组，n=29）。

主要观察指标

超声测量视神经鞘直径，近红外光谱法（NIRS）测量区域脑组织氧饱和度，分别在阻滞前（NIRS）、阻滞即刻、10、20 和 30 分钟后进行测量。

结果

L 组的平均 ONSD 值从基线的 4.4±0.2mm 增加到 20 分钟时的最大 4.5±0.2mm，H 组从基线的 4.5±0.3mm 增加到 10 分钟时的最大 4.8±0.3mm。H 组 29 例患者中有 8 例 ONSD 增加超过 10%，而 L 组无一例。两组的 CrSO 2 均减少不到 2.5%。