Effects of sevoflurane and propofol on the optic nerve sheath diameter in patients undergoing laparoscopic gynecological surgery: a randomized controlled clinical studies

Abstract

Background: The 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.

Methods: This 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, T_1h, T_2h …), after the end of surgery and the tracheal tube was removed (T_end), and before the patients were transferred to the ward (T_pacu).

Results: A 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 T_awake and other time points.

Conclusion: During 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 registration: clinicaltrials.gov, NCT03498235 . Retrospectively registered 1 March 2018. The manuscript adheres to CONSORT guidelines.

Keywords: CO2 pneumoperitoneum; ONSD, sevoflurane; Optic nerve sheath diameter; Propofol; Trendelenburg position.

Fig. 1

Flow diagram

Fig. 2

Comparison of ONSD at each time points between two groups. × meant there were statistical differences between two groups at time points T₁₅, T₃₀ and T₄₅ (Values of p were 0.031, 0.035 and 0.028). Comparison of ONSD at other time points, values of p were 0.984, 0.666, 0.646, 0.065, 0.211, 0.368 and 0.646 at T_awake, T_induction, T₀, T_1h, T_2h, T_end and T_pacu

Fig. 3

Comparison of MAP at each time points between two groups. There are no significant differences between two groups at each time points (Values of p were 0.066, 0.312, 0.912, 0.156, 0.125, 0.064, 0.166, 0.095, 0.092 and 0.290). MAP Mean arterial pressure

Fig. 4

Comparison of BIS at each time points between two groups. There are no significant differences between two groups at each time points (Values of p were 0.093、0.065, 0.191, 1.000, 0.970, 0.503 and 0.368). BIS Bispectral index