Effect of propofol and sevoflurane anesthesia on the optic nerve sheath: systematic review and metaanalysis
Efeito da anestesia com propofol e sevoflurano na bainha do nervo óptico: revisão sistemática e meta-análise
Rodolfo Otávio Tomaz Bertti, Luiz Antonio Vane, José Mariano Soares de Moraes, Paulo do Nascimento Junior, Lucas Fachini Vane, Norma Sueli Pinheiro Módolo, Matheus Fachini Vane
Abstract
Background
To facilitate the surgical view, laparoscopic and robotic pelvic surgeries require a pneumoperitoneum with the Trendelenburg position, which may result in elevated Intracranial Pressure (ICP). The choice of anesthetic agents may also influence ICP. Ultrasonographic evaluation of the Optic Nerve Sheath Diameter (ONSD) is a promising way to evaluate ICP. In this systematic review, we aimed to evaluate the ONSD, as an indirect estimation of ICP, in patients undergoing laparoscopic/robotic surgeries under pneumoperitoneum and Trendelenburg position.
Methods
A literature search was performed to identify prospective randomized clinical trials in which the primary endpoint was the evaluation of the ONSD using sevoflurane or propofol anesthesia after the onset of pneumoperitoneum and Trendelenburg position. The mean and the standard deviation of the ONSD in each intervention group were extracted from the included trials for analysis. Mean difference with 95% Confidence Interval (95% CI) was calculated.
Results
Five randomized controlled trials, with 277 subjects, were allocated to this study. Compared with the baseline, there was an increase in ONSD from 0.5h to 3 hours (p < 0.05) in both propofol and sevoflurane groups. Furthermore, propofol reduced the ONSD compared to sevoflurane (mean difference: -0.23 mm, 95% CI: -0.37 to -0.10; studies = 5; I2 = 23%).
Conclusions
There is evidence indicating, through ultrasonographic analysis of the ONSD, that propofol probably reduces ICP compared to sevoflurane in robotic and laparoscopic pelvic surgeries.
Keywords
Resumo
Introdução
Para facilitar a visão cirúrgica, cirurgias pélvicas laparoscópicas e robóticas exigem pneumoperitônio associado à posição de Trendelenburg, o que pode resultar em elevação da Pressão Intracraniana (PIC). A escolha dos agentes anestésicos também pode influenciar a PIC. A avaliação ultrassonográfica do Diâmetro da Bainha do Nervo Óptico (ONSD) é uma forma promissora de avaliar a ICP indiretamente. Nesta revisão sistemática, o objetivo foi avaliar o ONSD, como estimativa indireta da PIC, em pacientes submetidos a cirurgias laparoscópicas/robóticas com pneumoperitônio e posição de Trendelenburg.
Métodos
Foi realizada busca na literatura para identificar ensaios clínicos randomizados prospectivos em que o desfecho primário foi a avaliação do ONSD utilizando anestesia com sevoflurano ou propofol após início do pneumoperitônio e da posição de Trendelenburg. A média e o desvio padrão do ONSD em cada grupo de intervenção foram extraídos dos estudos incluídos para análise. Calculou-se a diferença média com intervalo de confiança de 95% (IC 95%).
Resultados
Cinco ensaios clínicos randomizados, totalizando 277 indivíduos, foram incluídos neste estudo. Comparado com a linha de base, houve aumento do ONSD entre 0,5 hora e 3 horas (p < 0,05) tanto nos grupos propofol quanto sevoflurano. Além disso, o propofol reduziu o ONSD em comparação com o sevoflurano (diferença média: -0,23 mm, IC 95%: -0,37 a -0,10; estudos = 5; I² = 23%).
Conclusão
Há evidências indicando, por meio da análise ultrassonográfica do ONSD, que o propofol provavelmente reduz a PIC em comparação ao sevoflurano em cirurgias pélvicas robóticas e laparoscópicas.
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References
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Submitted date:
12/20/2024
Accepted date:
05/23/2025
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