Effects of dexmedetomidine and sevoflurane on optic nerve sheath diameter and postoperative nausea and vomiting in patients undergoing microvascular decompression: a retrospective cohort study

Abstract

Background: Observe the effects of dexmedetomidine(Dex) and sevoflurane(Sev) on the optic nerve sheath diameter(ONSD) in patients undergoing microvascular decompression (MVD). Find the most appropriate anesthetic maintenance medication scheme to reduce intracranial pressure (ICP)fluctuation and reduce the incidence of adverse reactions such as postoperative nausea and vomiting(PONV).

Methods: In this retrospective cohort study, 90 patients undergoing elective MVD surgery were allocated into Groups P, D, and S. Maintenance of anaesthesia: Group P propofol(Propo) 4-12mg/(kg.h) + remifentanil 0.1-0.2ug/(kg.min); Group D Dex 0.4ug/(kg. h) + Propo 4-12mg/(kg.h) + remifentanil 0.1-0.2ug/(kg.min); Group S 1-2% Sev + Propo 4-12mg/(kg.h) + remifentanil 0.1-0.2ug/(kg.min). The changes in ultrasound-measured ONSD relative to baseline and the occurrence of PONV at different time periods under different anaesthetic maintenance regimens were compared.

Results: (1) ONSD values increased significantly from T1 (10 min after tracheal intubation) to T6 (on leaving the post-anaesthesia care unit (PACU)), compared with the same group at T0 (5 min before anaesthesia). ONSD values at each time point of T1-T6, were the lowest in the Group D and the highest in the Group S.(2)In this study, the incidence of PONV within 24 h after MVD was 38.9%, with the lowest in Group D and the highest in Group S. (3) T2 (10 min after lying on side in forward neck flexion)ONSD, T6 (on leaving the PACU)ONSD, the usage of Sev and Dex were associated with PONV, whereas the usage of 0.4ug/(kg.h) Dex was a protective factor.

Conclusions: Dex has a lower effect on ONSD of MVD during the perioperative phase than Sev, and it can, to a certain extent, reduce the fluctuation of ICP. Dex lowers the incidence of PONV within 24 h after MVD and acts as a protective factor for PONV.

Trial registration: The protocol of this study was registered at www.chictr.org.cn (07/02/2024,ChiCTR MR-50-24-010856).

Keywords: Dexmedetomidine(Dex); Microvascular decompression(MVD); Optic nerve sheath diameter(ONSD); Postoperative nausea and vomiting(PONV); Sevoflurane(Sev).

Fig. 1

The ultrasonogram of optic nerve sheath. Note: Distance 1 is 3 mm posterior to the retina,distance 2 is the optic nerve sheath diameter,and the scale is in millimetres

Fig. 2

Flow chart

Fig. 3

Trends of ONSD at each time point. Note: The horizontal coordinate T is the point in time when ONSD was measured, the vertical coordinate is the ONSD value in mm. The seven time points are listed below, T0: 5 min before anaesthesia, T1: 10 min after tracheal intubation, T2: 10 min after lying on side in forward neck flexion, T3: at the end of the operation, T4: 10 min after return to horizontal position, T5: 10 min after removal of the endotracheal tube, and T6: on leaving the PACU. T2 moment ONSD values of the three groups are peaked, *: P < 0.05, **: P < 0.01 statistically different