Effects of remimazolam and sevoflurane anesthesia on intracranial pressure and cerebral oxygenation in patients undergoinglaparoscopicsurgery in trendelenburg position
10.3969/j.issn.1006-5725.2025.13.021
- VernacularTitle:瑞马唑仑与七氟醚维持麻醉对腹腔镜Trendelenburg体位手术患者颅内压和脑氧合的影响
- Author:
Junpeng LIU
1
;
Shiya LIU
;
Zhen ZHANG
;
Changhong MIAO
;
Xihua LU
Author Information
1. 郑州大学附属肿瘤医院(河南省肿瘤医院)麻醉与围术期医学科(河南 郑州 450008)
- Publication Type:Journal Article
- Keywords:
trendelenburg position;
remimazolam;
sevoflurane;
optic nerve sheath diameter;
intra-cranial pressure
- From:
The Journal of Practical Medicine
2025;41(13):2088-2093
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the impacts of remimazolam on intraoperative intracranial pressure(ICP)and cerebral oxygenation in patients undergoing laparoscopic lower abdominal and pelvic surgery under CO2 pneumoperitoneum combined with Trendelenburg position.Methods Eighty-eight patients scheduled to undergo laparoscopic lower abdominal and pelvic surgery were randomly assigned to the remimazolam group(n=44)and the sevoflurane group(n=44).In the remimazolam group,continuous infusion of remimazolam at a rate of 1 mg/(kg·h)was administered for anesthesia maintenance.In contrast,the sevoflurane group inhaled 2％sevoflurane.Heart rate(HR),mean arterial pressure(MAP),peak airway pressure(Peak),plateau airway pressure(Plat),end-tidal CO2(PETCO2),regional cerebral oxygen saturation(rSO2),and optic nerve sheath diameter(ONSD)of both eyes were measured and recorded at the following time points:prior to anesthesia induction(T0),5 minutes after induction(T1),10 minutes(T2),30 minutes(T3),and 60 minutes(T4)after the establishment of pneumo-peritoneum in Trendelenburg position,as well as 30 minutes after deflation in the supine position(T5).Results No significant intergroup differences were detected in HR,MAP,Peak,Plat,or PETCO2 at any time point(P>0.05).In both groups,Peak and Plat values were significantly higher at T2-T4 compared to T1(P<0.05).Regard-ing the ONSD)no intergroup differences were noted at T0 and T1(P>0.05).From T2 to T5,ONSD in both groups increased significantly relative to T0..It gradually rose with the prolongation of pneumoperitoneum and Trendelen-burg positioning and showed a slight decrease at T5(P<0.05).Specifically,at T3 and T4,the remimazolam group exhibited significantly smaller ONSD values than the sevoflurane group(P<0.05).Throughout the study,no inter-group differences in rSO2 were observed(P>0.05).Conclusion In laparoscopic lower abdominal and pelvic surgeries performed in the Trendelenburg position,intravenous anesthesia with remimazolam may be more effective in mitigating the elevation of intracranial pressure compared to sevoflurane inhalation.
