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 hours under general anesthesia. The study was a randomized controlled study. The 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 minutes for first 1 hour and then once every hour until the end of the surgery（T15,T30,T45 ,T1h ,T2h…）, after end of surgery and the tracheal tube was removed (Tend), and before the patients were transferred to the ward (Tpacu).Results A significant difference in optic nerve sheath diameter was found between two groups at T15, T30, T45 (4.64±0.48mm and 4.50±0.29mm, respectively, p =0.031; 4.77±0.45mm and 4.62±0.28mm, respectively, p =0.036; 4.84±0.46mm and 4.65±0.30mm, respectively, p =0.012), while no significant difference at Tawake and other time points. Conclusion During laparoscopic gynecological surgery lasting more than 2 hours, the optic nerve sheath diameter gradually increased with establishment of the CO2 pneumoperitoneum and patient placement in the Trendelenburg position in both sevoflurane group and propofol group and returned to baseline 1 hour after surgery. No significant difference was observed between the two groups 1 hour after surgery. Trial registration clinicaltrials.gov，NCT03498235. Retrospectively registered 1 March2018,https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0007UMM&selectaction=Edit&uid=U00040C5&ts=39&cx=c7i8icThe manuscript adheres to CONSORT guidelines.