A Clinical Study Of Laparoscopic Cholecystectomy Anesthesia And Changes In Optic Nerve Sheath Diameter

Objective(s): To explore the effects of different anesthetic maintenance regimens on intracranial pressure and postoperative complications in patients undergoing laparoscopic cholecystectomy based on the measurement of optic nerve sheath diameter under ultrasound monitoring.Methods: A total of 162 patients aged 18~65 years who underwent laparoscopic cholecystectomy due to gallstones were selected.BMI 18~27kg/m2,ASA grade I ~ II;According to random number table method,patients were divided into 4 groups :propofol plus sevoflurane group(Group P,n=41),dexmedetomidine plus sevoflurane group(Group D,n=41),all-sevoflurane group(group S,n=40)and all-propofol group(Group Q,n=40).The anesthesia scheme was as follows: all the four groups were induced by the following scheme: intravenous administration of midazolam 0.02mg/kg,Sufentanil citrate 0.4μg/kg,propofol 2~2.5 mg/kg,rocuronium bromide 0.6mg/kg.Endotracheal intubation was performed after rocuronium took effect.After anesthesia induction,each group was maintained by the following regimen: Group P received 80 ~100mg/h propofol,0.6~0.7MAC inhalation of sevoflurane,0.15μg/(kg·min)reifentanil analgesic treatment,and added 1/3~1/2 rocuronium induction dose for 45 minutes.Group D was treated with dexmedetomidine 0.4μg/(kg·min),sevoflurane0.6~0.7MAC,and refentanil 0.15μg/(kg·min),and rocuronium induction dose 1/3~1/2was added for 45 minutes.Group S: Sevoflurane was given analgesic treatment with inhalation of 1.0~1.3MAC and refentanil 0.15μg/(kg·min),and rocuronium bromide induction dose was added for 45 minutes.After the last measurement,sevoflurane was turned off,oxygen flow was increased,and MAC was reduced to 0.Dexmedetomidine was injected 0.8μg/(kg·min)continuously until the end of surgery.Group Q: Propofol 4~12mg/(kg·h),remifentanil 0.15μg/(kg·min)analgesic treatment,plus rocuronium induction dose of 1/3~1/2 for 45 minutes.They were immediately after tracheal intubation(T0),before the establishment of pneumoperitoneum(T1),immediately after the beginning of pneumoperitoneum in head height and low left leaning position(T2),10 min after the beginning of pneumoperitoneum in head height and low left leaning position(T3),20 min after the beginning of pneumoperitoneum in head height and low left leaning position(T4),and 30 min after the beginning of pneumoperitoneum in head height and low left leaning position(T5),immediately after the end of pneumoperitoneum was changed to supine position(T6),ONSD in both eyes were measured.Intraoperative transfusion volume and blood loss were recorded.HR,MAP,Pplat,Ppeak,PETCO2 and pneumoperitoneum pressure at T0~T6 were recorded.The occurrence of adverse reactions 3h after operation was recorded in the four groups.Postoperative adverse reactions included headache,dizziness,nausea,vomiting,blurred vision,blindness,etc.Results:1.There were no significant differences in gender,age,ASA grading,BMI,operation time,anesthesia time,infusion volume and blood loss among the four groups(P>0.05).2.Pairwise comparison of T0-T6 time points among the four groups showed no statistical significance in MAP,HR,PETCO2,Pplat,Ppeak and pneumoperitoneum pressure(P>0.05).3.Intra-group comparison of the four groups showed the changes of ONSD value at T0-T6 time points as follows: in propofol combined sevoflurane group(group P)and dexmedetomidine combined sevoflurane group(group D),T1 was smaller than T0,T2,T3,T4 and T5(P <0.05),and there was no statistical difference between T1 and T6(P>0.05).T2 is less than T3,T4,T5(P<0.05),T3 is less than T4,T5(P<0.05),T4 is less than T5(P<0.05),T6 is less than T5,T4,T3,T2,T0(P<0.05);In sevoflurane group(group S),T1 was less than T0,T2,T3,T4,T5,T6(P<0.05),T2 was less than T3,T4,T5(P<0.05),T3 was less than T4,T5(P<0.05),and T4 was less than T5(P<0.05).T6 was smaller than T5,T4,T3,T2 and T0(P<0.05),and T6 was larger than T1(P<0.05).In group Q,T1 was smaller than T0,T2,T3,T4 and T5,and there was no statistical difference between T1 and T6.There was no statistical difference between T2 and T3,T4 and T5(P>0.05),T3 and T4 and T5(P>0.05),T4 was grater than T5(P<0.05),and T6 was less than T5,T4,T3,T2 and T0(P<0.05).4.The comparison of ONSD values at each time point between the four groups showed that there was no statistical difference in ONSD values at T0,T1 and T2 among the four groups(P>0.05).At T3,T4 and T5 time points,ONSD values of propofol combined with sevoflurane(group P)and dexmedetomidine combined with sevoflurane(group D)had no statistical difference(P>0.05),propofol combined with sevoflurane(group P),sevoflurane alone(group S)and propofol alone(group Q).The ONSD values of dexmedetomidine combined with sevoflurane group(group D),sevoflurane group(group S),propofol group(group Q),sevoflurane group(group S)and propofol group(group Q)were statistically different(P<0.05),that is,the ONSD value of group Q was lower than that of groups P and D,and that of groups P and D was lower than that of group S.There was no significant difference in the ONSD value among the four groups at T6 time point(P>0.05).5.Sevoflurane group(Group S)had a higher incidence of adverse reactions 3h after surgery,and there was a statistical difference between the group and the other groups(P<0.05).Female patients with age ≤54 years old,operation time >49min,infusion volume >950 m L,and intraoperative anesthesia regimen maintained with sevoflurane alone were independent predictors of adverse reactions 3h after surgery.At T5 time point,that is,30 min after the establishment of pneumooperitoneum,ONSD was greater than 5.15 mm.The AUC area,sensitivity and specificity were 0.733,68.75% and 71.54% respectively.Conclusion(s):1.The intraoperative ONSD value of patients undergoing laparoscopic cholecystectomy widened with the extension of the time to establish pneumoperitoneum.2.Intravenous anesthetics(propofol,dexmedetomidine)can reduce the intraoperative widening of ONSD compared with inhalation anesthetics(sevoflurane).Intravenous anesthesia with propofol can eliminate the effect of pneumoperitoneum on ONSD in patients undergoing laparoscopic cholecystectomy.3.Anesthesia regimens dominated by inhaled anesthetics(sevoflurane)resulted in a higher incidence of adverse reactions 3h after surgery,but remission was achieved within 48 h.4.30 min after the establishment of operitoneum,the ONSD was greater than5.15 mm,and the AUC area of adverse reactions predicted at 3h after the operation was 0.733,the sensitivity was 68.75%,and the specificity was 71.54%.