Abstract
BackgroundThe results of studies on changes in intracranial pressure in patients undergoing laparoscopic surgery are inconsistent. Meanwhile, previous neurosurgery studies have suggested that propofol and sevoflurane have inconsistent effects on cerebral blood flow and cerebrovascular self-regulation. The purpose of this study is to compare changes in the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery under anesthetic maintenance with propofol versus sevoflurane.MethodsThis study included 110 patients undergoing laparoscopic gynecological surgery with an estimated operative time of more than 2 h under general anesthesia. The study was a randomized controlled study. The optic nerve sheath diameter (ONSD) at various time points was measured by ultrasound, including when the patients entered the operating room (Tawake), after successful anesthesia induction and endotracheal intubation (Tinduction), when the body position was adjusted to the Trendelenburg position and the CO2 pneumoperitoneum pressure reached 14 mmHg, which was recorded as T0. Then, measurements were conducted every 15 min for the first 1 h and then once every hour until the end of the surgery (T15, T30, T45, T1h, T2h …), after the end of surgery and the tracheal tube was removed (Tend), and before the patients were transferred to the ward (Tpacu).ResultsA significant difference in optic nerve sheath diameter was found between two groups at T15, T30, T45 (4.64 ± 0.48 mm and 4.50 ± 0.29 mm, respectively, p = 0.031;4.77 ± 0.45 mm and 4.62 ± 0.28 mm, respectively, p = 0.036;4.84 ± 0.46 mm and 4.65 ± 0.30 mm, respectively, p = 0.012), while there was no significant difference at Tawake and other time points.ConclusionDuring laparoscopic gynecological surgery lasting more than 2 h, the optic nerve sheath diameter was slightly larger in the propofol group than that in the sevoflurane group in the first 45 min. No significant difference was observed between the two groups 1 h after surgery.Trial registrationclinicaltrials.gov, NCT03498235. Retrospectively registered 1 March 2018.The manuscript adheres to CONSORT guidelines.
Highlights
The results of studies on changes in intracranial pressure in patients undergoing laparoscopic surgery are inconsistent
A total of 110 patients who were classified as class I-II according to the standards and guidelines of the American Society of Anaesthesiologists (ASA) and underwent elective laparoscopic gynecological surgery under general anesthesia for an estimated operative time > 2 h from February 2018 to June 2020 were included in the study
The time points at which the optic nerve sheath diameter (ONSD) was ultrasonically measured were when the patients entered the operating room (Tawake), after anesthesia induction and endotracheal intubation (Tinduction), and when the body position was adjusted to the Trendelenburg position and the CO2 pneumoperitoneum pressure reached 14 mmHg, which was recorded as T0
Summary
The results of studies on changes in intracranial pressure in patients undergoing laparoscopic surgery are inconsistent. Previous neurosurgery studies have suggested that propofol and sevoflurane have inconsistent effects on cerebral blood flow and cerebrovascular self-regulation. The purpose of this study is to compare changes in the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery under anesthetic maintenance with propofol versus sevoflurane. The CO2 pneumoperitoneum causes hypercapnia, cerebrovascular dilation, increased intracranial cerebral blood flow, and increased intracranial pressure [3]. These effects rarely result in serious neurological complications such as cerebral haemorrhage and cerebral oedema [4], mild neurological complications, such as nausea, vomiting, and headaches, occur sometimes [5]. In a study of patients undergoing robot-assisted laparoscopic prostate surgery under sevoflurane anesthesia, Verdonck et al found that optic nerve sheath diameter (ONSD) remained unchanged throughout the perioperative period [7]
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