Bertti Rodolfo Otávio Tomaz, Vane Luiz Antonio, de Moraes José Mariano Soares, Junior Paulo do Nascimento, Vane Lucas Fachini, Módolo Norma Sueli Pinheiro, Vane Matheus Fachini
Universidade Estadual Paulista (UNESP), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
Universidade Estadual Paulista (UNESP), Departamento de Especialidades Cirúrgicas e Anestesiologia, Botucatu, SP, Brazil.
Braz J Anesthesiol. 2025 Jun 4;75(5):844646. doi: 10.1016/j.bjane.2025.844646.
To facilitate the surgical view, laparoscopic and robotic pelvic surgeries require a pneumoperitoneum with the Trendelenburg position, which may result in elevated Intracranial Pressure (ICP). The choice of anesthetic agents may also influence ICP. Ultrasonographic evaluation of the Optic Nerve Sheath Diameter (ONSD) is a promising way to evaluate ICP. In this systematic review, we aimed to evaluate the ONSD, as an indirect estimation of ICP, in patients undergoing laparoscopic/robotic surgeries under pneumoperitoneum and Trendelenburg position.
A literature search was performed to identify prospective randomized clinical trials in which the primary endpoint was the evaluation of the ONSD using sevoflurane or propofol anesthesia after the onset of pneumoperitoneum and Trendelenburg position. The mean and the standard deviation of the ONSD in each intervention group were extracted from the included trials for analysis. Mean difference with 95% Confidence Interval (95% CI) was calculated.
Five randomized controlled trials, with 277 subjects, were allocated to this study. Compared with the baseline, there was an increase in ONSD from 0.5h to 3 hours (p < 0.05) in both propofol and sevoflurane groups. Furthermore, propofol reduced the ONSD compared to sevoflurane (mean difference: -0.23 mm, 95% CI: -0.37 to -0.10; studies = 5; I = 23%).
There is evidence indicating, through ultrasonographic analysis of the ONSD, that propofol probably reduces ICP compared to sevoflurane in robotic and laparoscopic pelvic surgeries.
为便于手术视野，腹腔镜和机器人辅助盆腔手术需要在头低脚高位下建立气腹，这可能导致颅内压（ICP）升高。麻醉药物的选择也可能影响颅内压。超声评估视神经鞘直径（ONSD）是评估颅内压的一种有前景的方法。在本系统评价中，我们旨在评估在气腹和头低脚高位下行腹腔镜/机器人辅助手术的患者中，ONSD作为颅内压的间接估计指标的情况。
进行文献检索，以确定前瞻性随机临床试验，其中主要终点是在气腹和头低脚高位开始后，使用七氟醚或丙泊酚麻醉评估ONSD。从纳入的试验中提取每个干预组中ONSD的平均值和标准差进行分析。计算95%置信区间（95%CI）的平均差异。
五项随机对照试验，共277名受试者，被纳入本研究。与基线相比，丙泊酚组和七氟醚组在0.5小时至3小时时ONSD均增加（p<0.05）。此外，与七氟醚相比，丙泊酚降低了ONSD（平均差异：-0.23mm，95%CI：-0.37至-0.10；研究数量=5；I²=23%）。
有证据表明，在机器人辅助和腹腔镜盆腔手术中，通过对ONSD的超声分析，与七氟醚相比，丙泊酚可能降低颅内压。
