Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, College of Medicine, Seoul National University, Boramae-ro 5, Dongjak-gu, Seoul, 07061, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
J Anesth. 2023 Dec;37(6):880-887. doi: 10.1007/s00540-023-03248-7. Epub 2023 Sep 1.
During middle ear surgery, the patient's head is turned away from the surgical site, which may increase the intracranial pressure. Anesthetics also affect the intracranial pressure. The optic nerve sheath diameter (ONSD) measured using ultrasonography is a reliable marker for estimating the intracranial pressure. This aim of this study was to investigate the effect of sevoflurane and propofol on the ONSD in patients undergoing middle ear surgery.
Fifty-eight adult patients were randomized into sevoflurane group (n = 29) or propofol group (n = 29). The ONSD was measured using ultrasound after anesthesia induction before head rotation (T0), and at the end of surgery (T1). The occurrence and severity of postoperative nausea and vomiting (PONV) were assessed 1 h after the surgery.
The ONSD was significantly increased from T0 to T1 in the sevoflurane group [4.3 (0.5) mm vs. 4.9 (0.6) mm, respectively; P < 0.001] and the propofol group [4.2 (0.3) mm vs. 4.8 (0.5) mm, respectively; P < 0.001]. No significant difference was observed in the ONSD at T0 (P = 0.267) and T1 (P = 0.384) between the two groups. The change in the ONSD from T0 to T1 was not significantly different between the sevoflurane and propofol groups [0.6 (0.4) mm vs. 0.6 (0.3) mm, respectively; P = 0.972]. The occurrence and severity of PONV was not significantly different between the sevoflurane and propofol groups (18% vs. 0%, respectively; P = 0.053).
The ONSD was significantly increased during middle ear surgery. No significant difference was observed in the amount of ONSD increase between the sevoflurane and propofol groups.
在中耳手术中，患者的头部会转向远离手术部位，这可能会增加颅内压。麻醉也会影响颅内压。视神经鞘直径（ONSD）通过超声测量是一种可靠的指标，可用于估计颅内压。本研究旨在探讨七氟醚和丙泊酚对行中耳手术患者 ONSD 的影响。
将 58 例成年患者随机分为七氟醚组（n=29）或丙泊酚组（n=29）。在头位旋转前麻醉诱导后（T0）和手术结束时（T1）使用超声测量 ONSD。术后 1 小时评估术后恶心呕吐（PONV）的发生和严重程度。
七氟醚组（4.3（0.5）mm 比 4.9（0.6）mm，P<0.001）和丙泊酚组（4.2（0.3）mm 比 4.8（0.5）mm，P<0.001）的 ONSD 从 T0 到 T1 均显著增加。两组间 T0 时（P=0.267）和 T1 时（P=0.384）的 ONSD 无显著差异。七氟醚和丙泊酚组从 T0 到 T1 的 ONSD 变化无显著差异[0.6（0.4）mm 比 0.6（0.3）mm，P=0.972]。七氟醚和丙泊酚组的 PONV 发生率和严重程度无显著差异（18%比 0%，P=0.053）。
中耳手术期间 ONSD 显著增加。七氟醚和丙泊酚组 ONSD 增加量无显著差异。
