Ray Swarup, Parmar Uditi, Dias Raylene, Saxen Vishal, Mujpurwala Fatema, Anu K A
Department of Paediatric Anaesthesiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Paediatric Anaesthesiology, Army Hospital (Research and Referral), Delhi Cantt, Delhi, India.
J Anaesthesiol Clin Pharmacol. 2025 Apr-Jun;41(2):298-303. doi: 10.4103/joacp.joacp_77_24. Epub 2024 Dec 16.
Laparoscopic surgery involves creation of carbondioxide (CO) pneumoperitoneum leading to a rise in intracranial pressure (ICP), which can cause expansion of optic nerve sheath diameter(ONSD).We aimed to study the magnitude of changes in ONSD occurring during pediatric laparoscopic surgery and correlate them with changes in end-tidal CO (EtCO), intrabdominal pressure (IAP), and a change in patient position (P).
Thirty-five pediatric patients between 1 and 12 years undergoing laparoscopic surgeries under general anesthesia were included.The ONSD, EtCO, IAP, and position (P) in degrees from supine were recorded 15 min post-anesthesia induction(T1) and 30 min following the establishment of pneumoperitoneum (T2).The difference between the two groups was analyzed using a paired or unpaired -test for quantitative variables and using Chi-square or Fisher's exact test for qualitative data.Correlation between two quantitative variables was performed using Pearson's correlation coefficient.
Mean ONSD showed a significant change ( < 0.001) 30 min (T2) following pneumoperitoneum increasing by an average of 0.04cm as compared to 15 min (T1) post-anesthesia induction (0.57 ± 0.06 vs. 0.61 ± 0.06). There was a moderate to strong positive correlation between change in ONSD and change in EtCO(correlation coefficient = 0.629, = 0.001) 30 min post pneumoperitoneum. There was a weak correlation between change in ONSD and change in position (correlation coefficient = 0.276) and a very weak correlation between change in ONSD and change in IAP (correlation coefficient = 0.19).
Laparoscopic surgeries in children can cause significant increases in ICP as measured by the ONSD; changes in EtCO are the predominant factor responsible. Increasing minute ventilation to maintain normal EtCO may help mitigate changes in ICP in children undergoing laparoscopic surgery.
腹腔镜手术需要建立二氧化碳（CO₂）气腹，这会导致颅内压（ICP）升高，进而可能引起视神经鞘直径（ONSD）增大。我们旨在研究小儿腹腔镜手术期间ONSD的变化幅度，并将其与呼气末CO₂（EtCO₂）、腹内压（IAP）以及患者体位变化（P）相关联。
纳入35例年龄在1至12岁之间接受全身麻醉下腹腔镜手术的小儿患者。在麻醉诱导后15分钟（T1）以及气腹建立后30分钟（T2）记录ONSD、EtCO₂、IAP以及相对于仰卧位的体位（P）度数。对于定量变量，使用配对或非配对t检验分析两组之间的差异；对于定性数据，使用卡方检验或Fisher精确检验。使用Pearson相关系数对两个定量变量之间的相关性进行分析。
气腹后30分钟（T2）时，平均ONSD出现显著变化（P<0.001），与麻醉诱导后15分钟（T1）相比平均增加了0.04cm（0.57±0.06 vs. 0.61±0.06）。气腹后30分钟，ONSD变化与EtCO₂变化之间存在中度至强的正相关性（相关系数=0.629，P=0.001）。ONSD变化与体位变化之间存在弱相关性（相关系数=0.276），ONSD变化与IAP变化之间存在非常弱的相关性（相关系数=0.19）。
小儿腹腔镜手术可导致通过ONSD测量的ICP显著升高；EtCO₂变化是主要影响因素。增加分钟通气量以维持正常EtCO₂可能有助于减轻小儿腹腔镜手术期间ICP的变化。
