Department of Anesthesiology and Reanimation, Faculty of Medicine, Giresun University, Giresun, Turkey.
Eur Rev Med Pharmacol Sci. 2024 Feb;28(4):1407-1416. doi: 10.26355/eurrev_202402_35462.
This study aims to evaluate the effects of total intravenous anesthesia (propofol), volatile anesthesia (desflurane), and spinal anesthesia on intraocular pressure (IOP) during lumbar disc herniation surgery in the prone position.
This randomized controlled trial was conducted between January 2022 and January 2023. The study included 75 patients with lumbar disc herniation between the ages of 18-75, with the American Society of Anesthesiologists (ASA) 1-2. The patients were randomly divided into 3 groups: propofol, desflurane, and spinal. IOP was measured at 5-time points throughout surgery, including baseline (T1), 10 minutes after anesthesia (T2), 10 minutes after prone positioning (T3: early prone), 30 minutes after prone positioning (T4: late prone), and 10 minutes after returning to the supine position (T5). Hemodynamic parameters were measured at these time points. Hemoglobin and hematocrit values were measured preoperatively and on the first postoperative day.
There were 25 patients in each group. The groups were similar in terms of all characteristics except for weight and body mass index, which were lower in the spinal group. Propofol recipients had significantly higher T3 (prone) IOP compared to desflurane recipients (p = 0.001). We found no significant differences between groups in terms of T1, T2, T4, and T5 IOP. Multivariable linear regression revealed that diabetes mellitus (p = 0.016) and high T1 IOP (p = 0.001) were independently associated with higher T3 IOP. In addition, we found that the desflurane (p < 0.001) and spinal (p = 0.002) groups had significantly lower T3 IOP compared to propofol recipients after adjusting for diabetes mellitus and T1 IOP.
Our findings suggest that volatile anesthesia (desflurane) and spinal anesthesia are linked to lower IOP in the prone position among patients undergoing spinal surgery, in comparison to those receiving total intravenous anesthesia. There is a need to test the results with more comprehensive, population-based studies in different patient groups. ClinicalTrials gov ID: NCT06070480.
本研究旨在评估全静脉麻醉（丙泊酚）、挥发性麻醉（地氟醚）和脊髓麻醉对俯卧位腰椎间盘突出症手术期间眼内压（IOP）的影响。
这是一项于 2022 年 1 月至 2023 年 1 月期间进行的随机对照试验。研究纳入了年龄在 18-75 岁之间、美国麻醉医师协会（ASA）1-2 级的 75 例腰椎间盘突出症患者。患者被随机分为 3 组：丙泊酚组、地氟醚组和脊髓组。在手术过程中，我们在 5 个时间点测量了 IOP，包括基线（T1）、麻醉后 10 分钟（T2）、俯卧位后 10 分钟（T3：早期俯卧位）、俯卧位后 30 分钟（T4：晚期俯卧位）和返回仰卧位后 10 分钟（T5）。在这些时间点测量了血流动力学参数。在术前和术后第 1 天测量了血红蛋白和红细胞压积值。
每组各有 25 例患者。除了体重和体重指数外，所有特征在各组之间均相似，而体重指数和体重指数在脊髓组中较低。与地氟醚组相比，丙泊酚组患者 T3（俯卧位）的 IOP 显著更高（p=0.001）。各组之间在 T1、T2、T4 和 T5 IOP 方面无显著差异。多变量线性回归显示，糖尿病（p=0.016）和高 T1 IOP（p=0.001）与 T3 IOP 升高独立相关。此外，我们发现，在地氟醚（p<0.001）和脊髓（p=0.002）组中，与丙泊酚组相比，在调整了糖尿病和 T1 IOP 后，T3 IOP 显著降低。
我们的研究结果表明，与接受全静脉麻醉的患者相比，挥发性麻醉（地氟醚）和脊髓麻醉在接受脊柱手术的患者中俯卧位时的 IOP 较低。需要使用更全面的、基于人群的研究在不同的患者群体中检验这些结果。临床试验注册号：NCT06070480。
