Kim Hyerim, Seol Taikyung, Chang Jee-Eun, Won Dongwook, Lee Jung-Man, Kim Tae Kyong, Park Eun Bi, Hwang Jin-Young
Department of Anesthesiology and Pain Medicine, College of Medicine, SMG-SNU Boramae Medical Center, Seoul National University, Boramae-Ro 5, Dongjak-gu, Seoul, 156-707, Republic of Korea.
Department of Anesthesiology and Pain Medicine, Sheikh Khalifa Specialty Hospital, RAK, United Arab Emirates.
J Anesth. 2025 Mar 20. doi: 10.1007/s00540-025-03482-1.
Pneumoperitoneum and the steep Trendelenburg position during laparoscopic gynecological surgery may increase intracranial pressure, which can be estimated using ultrasound measurement of the optic nerve sheath diameter (ONSD). In this study, we evaluated the effect of obesity on ONSD in patients undergoing laparoscopic gynecological surgery.
Sixty-eight patients who underwent laparoscopic gynecological surgery were allocated to either the non-obese (n = 34) or obese (n = 34) groups. ONSD was assessed using ultrasound after anesthesia induction, at 30 and 60 min after pneumoperitoneum and Trendelenburg positioning, and at 10 and 60 min, and 24 h after desufflation and return to the supine position. Postoperative nausea and vomiting (PONV) and headache were evaluated 1 and 24 h after surgery.
ONSD increased significantly during pneumoperitoneum and Trendelenburg positioning in both groups (P < 0.001, respectively) and was higher in the obese group at each time point throughout and after surgery (P < 0.007, respectively). The increased ONSD during surgery returned to baseline 24 h after desufflation in the non-obese group, but not in the obese group. The incidence of PONV 1 h after surgery was significantly higher in the obese group than in the non-obese group (59% vs. 21%, respectively; P = 0.001). The incidence of PONV 24 h after surgery and postoperative headaches were not different between the two groups.
ONSD was significantly higher in the obese group than in the non-obese group throughout and after laparoscopic gynecological surgery. The increased ONSD during surgery did not return to baseline even 24 h after desufflation in the obese group.
腹腔镜妇科手术中的气腹和极度头低脚高位可能会增加颅内压，这可以通过超声测量视神经鞘直径（ONSD）来评估。在本研究中，我们评估了肥胖对接受腹腔镜妇科手术患者ONSD的影响。
68例行腹腔镜妇科手术的患者被分为非肥胖组（n = 34）和肥胖组（n = 34）。在麻醉诱导后、气腹和头低脚高位摆放后30分钟和60分钟、放气并恢复仰卧位后10分钟、60分钟和24小时，使用超声评估ONSD。在术后1小时和24小时评估术后恶心呕吐（PONV）和头痛情况。
两组在气腹和头低脚高位摆放期间ONSD均显著增加（P均<0.001），并且在手术全程及术后的每个时间点，肥胖组的ONSD均更高（P均<0.007）。非肥胖组在放气后24小时，手术期间增加的ONSD恢复至基线水平，但肥胖组未恢复。肥胖组术后1小时PONV的发生率显著高于非肥胖组（分别为59%和21%；P = 0.001）。两组术后24小时PONV的发生率和术后头痛情况无差异。
在腹腔镜妇科手术全程及术后，肥胖组的ONSD显著高于非肥胖组。肥胖组在手术期间增加的ONSD即使在放气后24小时也未恢复至基线水平。
