Effects Of Esketamine And Dexmedetomidine On Optic Nerve Sheath Diameter In Patients Undergoing Gynecological Laparoscopic Surgery

Part One Effects of different doses of esketamine on optic nerve sheath diameter in patients undergoing gynecological laparoscopic surgeryObjective:The subject observes the changes of optical nerve sheath diameter（ONSD）of patients treated with different doses of esketamine in gynecological laparoscopic surgery under head-down and foot-high postures to understand its impact on intracranial pressure,and explored whether esketamine could be safely used in patients with gynecological laparoscopic surgery,so as to provide more ideas and reference materials for monitoring and managing intracranial pressure in such surgery,and provide theoretical basis for clinical decision-making.Methods:90 patients undergoing elective gynecological head-down laparoscopic surgery in our hospital were selected and randomly divided into three groups:low-dose esketamine group（group K1）,high-dose esketamine group（group K2）and control group without esketamine（group O）,with 30 cases in each group.The K1 and K2 groups were anesthetized with esketamine 0.5 mg/kg and 1 mg/kg,respectively,and the O group was anesthetized with sufentanil 0.5μg/kg.The K1 and K2 groups were subjected to continuous intravenous infusion of esketamine at the rates of 0.5 mg/（kg·h）and 1mg/（kg·h）respectively.The O group was subjected to intravenous infusion of remifentanil at the rate of 0.2μg/（kg·min）.The following indexes were recorded:（1）general conditions:height,age,weight,operation time,anesthesia time,pneumoperitoneum maintenance time in head-low and foot-high position,cumulative intraoperative bleeding and total fluid volume.（2）Intraoperative conditions:mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（Sp O₂）,bispectral index（BIS）,binocular onsd and eyeball transverse diameter were recorded before anesthesia induction（T0）,5 min after tracheal intubation in the supine position（T1）,10 min、30 min and 60 min after CO₂ pneumoperitoneum combined with head-low and foot-high body position（T2-T4）,and 5 min after CO₂pneumoperitoneum was closed to restore the supine position（T5）.（3）Serum S100βprotein and neuron specific enolase（NSE）were measured at T0 and T5.（4）Adverse reactions:the occurrence of intraoperative adverse reactions.Results:There was no significant difference in the general condition and the basic value of preoperative indexes among the three groups（all P>0.05）.The ONSD and ONSD/ETD ratios in group O,K1 and K2 at T2～T5 time were higher than those at T0 time,the differences were statistically significant（all P<0.05）.The value of ONSD in group K2was higher than that in group O,and the difference was statistically significant（all P<0.05）.The values of HR and MAP in K1 and K2 groups at T1～T5 were higher than those in O group,and the differences were statistically significant（all P<0.05）.The values of HR and MAP in K1 and K2 groups at T2～T5 time were lower than those at T0 time,and the differences were statistically significant（all P<0.05）.Conclusion:1.In laparoscopic surgery,the values of ONSD and ONSD/ETD increased during CO₂pneumoperitoneum combined with head-low and foot-high position,suggesting the increased in intracranial pressure.2.0.5mg/kg esketamine will not increase the value of ONSD,ONSD/ETD in gynecological laparoscopic surgery,suggesting that it will not increase intracranial pressure.Part Two Effects of different doses of dexmedetomidine on optic nerve sheath diameter in patients undergoing gynecological laparoscopic surgeryObjective :By observing the changes of optic nerve sheath diameter（ONSD）in gynecological laparoscopic surgery under head-down and foot-high position,to understand the changes of intracranial pressure in patients,and to explore the effects of different doses of dexmedetomidine on the changes,so as to provide reference ideas for clinical practice management of intracranial pressure in such surgery.Methods:90 patients undergoing elective gynecological head-down laparoscopic surgery were selected and randomly divided into low-dose experimental group（D1 group）,high-dose experimental group（D2 group）and control group（P group）,with 30 cases in each group.Patients in D1 group and D2 group received continuous intravenous infusion of dexmedetomidine 1ug / kg for 10 min before induction of anesthesia,,and then continued intravenous infusion at the rate of 0.4 ug/（kg·h）and 0.6 ug/（kg·h）respectively.Patients in group P received the same volume of normal saline,and all stopped intravenous infusion 30 min before the end of the operation.The following indexes were recorded:（1）general conditions: height,age,weight,operation time,anesthesia time,pneumoperitoneum maintenance time in head-low and foot-high position,cumulative intraoperative bleeding and total fluid volume.（2）Intraoperative conditions: mean arterial pressure（MAP）,heart rate（HR）,pulse oxygen saturation（Sp O2）,binocular onsd were recorded at the time of entering the room（T0）,10 min after intravenous pumping（T1）,10 min、30 min and 60 min after head low foot high position combined with CO2 pneumoperitoneum（T2⁴）,and 10 min after closing CO2 pneumoperitoneum to restore supine position（T5）.（4）Adverse reactions : the incidence of bradycardia in the operation center and the use of atropine.Results:There was no significant difference in the general condition and the basic value of preoperative indicators among the three groups（all P > 0.05）.The values of ONSD in group P,D1 and D2 at T2^T5 time were higher than those at T0（all P<0.05）,and the map and HR were lower than that at t0 time point（all P < 0.05）.The values of onsd and HR in D1 and D2 groups at T1 time were lower than those at t0 time,and the difference was statistically significant（P < 0.05）.The values of ONSD and HR in D1 and D2 groups were lower than those of P group,and the difference was statistically significant（P < 0.05）.The incidence of bradycardia in group D1 and D2 was significantly higher than that in group P（P < 0.05）.There was no significant difference in the incidence of intraoperative bradycardia and the use of atropine between group D1 and D2（P > 0.05）.Conclusion :1.In laparoscopic surgery,the values of ONSD gradually increased during CO2 pneumoperitoneum combined with head-low and foot-high position,suggesting the increased in intracranial pressure.2.Dexmedetomidine with maintenance doses of 0.4ug/kg/h and 0.6ug/kg/h can alleviate the increase of ONSD during gynecological laparoscopic surgery,suggesting that it can alleviate the increase of intracranial pressure.3.Dexmedetomidine with a maintenance dose of 0.4 ug / kg / h can make the circulation tend to be more stable.