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Effects of remimazolam and sevoflurane anesthesia on intracranial pressure and cerebral oxygenation in patients undergoinglaparoscopicsurgery in trendelenburg position
Received date: 2025-04-10
Online published: 2025-07-18
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 pneumoperitoneum 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）. Regarding 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 Trendelenburg 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 intergroup 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.
Junpeng LIU , Shiya LIU , Zhen ZHANG , Changhong MIAO , Xihua. LU . Effects of remimazolam and sevoflurane anesthesia on intracranial pressure and cerebral oxygenation in patients undergoinglaparoscopicsurgery in trendelenburg position[J]. The Journal of Practical Medicine, 2025 , 41(13) : 2088 -2093 . DOI: 10.3969/j.issn.1006-5725.2025.13.021
| [1] | CHEN K， WANG L， WANG Q， et al. Effects of pneumoperitoneum and steep Trendelenburg position on cerebral hemodynamics during robotic-assisted laparoscopic radical prostatectomy： A randomized controlled study ［J］. Medicine （Baltimore）， 2019， 98（21）： e15794. doi:10.1097/md.0000000000015794 |
| [2] | MATSUOKA T， ISHIYAMA T， SHINTANI N， et al. Changes of cerebral regional oxygen saturation during pneumoperitoneum and Trendelenburg position under propofol anesthesia： A prospective observational study ［J］. BMC Anesthesiol， 2019， 19（1）： 72. doi:10.1186/s12871-019-0736-4 |
| [3] | MCCULLOCH T J， VISCO E， LAM A M. Graded hypercapnia and cerebral autoregulation during sevoflurane or propofol anesthesia ［J］. Anesthesiology， 2000， 93（5）： 1205-1209. doi:10.1097/00000542-200011000-00012 |
| [4] | YAN S， LI Q， HE K. The effect of esketamine combined with propofol-induced general anesthesia on cerebral blood flow velocity： A randomized clinical trial ［J］. BMC Anesthesiol， 2024， 24（1）： 66. doi:10.1186/s12871-024-02446-4 |
| [5] | SIDDIQI A Z， FROESE L， GOMEZ A， et al. The effect of burst suppression on cerebral blood flow and autoregulation： A scoping review of the human and animal literature ［J］. Front Physiol， 2023， 14：1204874. doi:10.3389/fphys.2023.1204874 |
| [6] | SHAMS S， PROKOPIOU P， ESMAELBEIGI A， et al. Modeling the dynamics of cerebrovascular reactivity to carbon dioxide in fMRI under task and resting-state conditions ［J］. Neuroimage， 2023， 265：119758. doi:10.1016/j.neuroimage.2022.119758 |
| [7] | KIM S J， KWON J Y， CHO A R， et al. The effects of sevoflurane and propofol anesthesia on cerebral oxygenation in gynecological laparoscopic surgery ［J］. Korean J Anesthesiol， 2011， 61（3）： 225-232. doi:10.4097/kjae.2011.61.3.225 |
| [8] | MU?OZ H R， Nú?EZ G E， DE LA FUENTE J E， et al. The effect of nitrous oxide on jugular bulb oxygen saturation during remifentanil plus target-controlled infusion propofol or sevoflurane in patients with brain tumors ［J］. Anesth Analg， 2002， 94（2）： 389-392， table of contents. doi:10.1213/00000539-200202000-00030 |
| [9] | ZHOU H， NEUDECKER V， PEREZ-ZOGHBI J F， et al. Age-dependent cerebral vasodilation induced by volatile anesthetics is mediated by NG2（+） vascular mural cells ［J］. Commun Biol， 2024， 7（1）： 1519. doi:10.1038/s42003-024-07200-7 |
| [10] | OGAWA Y， IWASAKI K， AOKI K， et al. The different effects of midazolam and propofol sedation on dynamic cerebral autoregulation ［J］. Anesth Analg， 2010， 111（5）： 1279-1284. doi:10.1213/ane.0b013e3181f42fc0 |
| [11] | 许庆龄， 吕远志， 宁恒艺， 等. 近日节律对全麻手术患者麻醉诱导期甲苯磺酸瑞马唑仑镇静深度的影响 ［J］. 实用医学杂志， 2025， 41（3）： 403-408. |
| [12] | KURTH C D， LEVY W J， MCCANN J. Near-infrared spectroscopy cerebral oxygen saturation thresholds for hypoxia-ischemia in piglets ［J］. J Cereb Blood Flow Metab， 2002， 22（3）： 335-341. doi:10.1097/00004647-200203000-00011 |
| [13] | 辛超， 高巨， 葛亚丽， 等. 驱动压导向个体化呼气末正压对机器人辅助前列腺癌根治术老年患者术中脑血流及局部脑氧饱和度的影响 ［J］. 实用医学杂志， 2023， 39（12）： 1524-1528，1535. doi:10.3969/j.issn.1006-5725.2023.12.011 |
| [14] | ZHENG C， WANG B， FU J， et al. Effect of phenylephrine versus ephedrine on the incidence of postoperative delirium in olderly adults undergoing knee arthroplasty under general anesthesia： A single-center trial ［J］. Sci Rep， 2024， 14（1）： 17333. doi:10.1038/s41598-024-68273-2 |
| [15] | SLUPE A M， KIRSCH J R. Effects of anesthesia on cerebral blood flow， metabolism， and neuroprotection ［J］. J Cereb Blood Flow Metab， 2018， 38（12）： 2192-2208. doi:10.1177/0271678x18789273 |
| [16] | NUERMAIMAITI A， LI S S， LI Y Q， et al. Effects of anesthesia on cerebral oxygen saturation and prevention of brain injury during carotid endarterectomy ［J］. J Cardiothorac Surg， 2025， 20（1）： 131. doi:10.1186/s13019-025-03342-9 |
| [17] | PARK C G， LEE D， JUNG W S， et al. Impact of Remimazolam versus Sevoflurane Anesthesia on Cerebral Oxygenation and Intracranial Pressure during Gynecological Laparoscopy with Mild Hypercapnia ［J］. Med Sci Monit， 2023， 29：e941315. doi:10.12659/msm.941315 |
| [18] | HIRZALLAH M I， LOCHNER P， HAFEEZ M U， et al. Optic Nerve Sheath Diameter Point-of-Care Ultrasonography Quality Criteria Checklist： An International Consensus Statement on Optic Nerve Sheath Diameter Imaging and Measurement ［J］. Crit Care Med， 2024， 52（10）： 1543-1556. doi:10.1097/ccm.0000000000006345 |
| [19] | 王祖文， 黎合剑， 张静， 等. 不同通气模式对老年腹腔镜结直肠癌手术患者视神经鞘直径的影响 ［J］. 实用医学杂志， 2021， 37（17）： 2224-2228. |
| [20] | AGGARWAL S， KNIGHT D K， BOISVERT C J. Measuring Optic Nerve Sheath Diameter as a Proxy for Intracranial Pressure ［J］. JAMA Ophthalmol， 2018， 136（11）： 1310. doi:10.1001/jamaophthalmol.2018.3432 |
| [21] | GULOGLU H， CETINKAYA D， OGE T， et al. Evaluation of the effect of trendelenburg position duration on intracranial pressure in laparoscopic hysterectomies using ultrasonographic optic nerve sheath diameter measurements ［J］. BMC Anesthesiol， 2024， 24（1）： 238. doi:10.1186/s12871-024-02624-4 |
| [22] | KALMAR A F， DE LEY G， VAN DEN BROECKE C， et al. Influence of an increased intracranial pressure on cerebral and systemic haemodynamics during endoscopic neurosurgery： An animal model ［J］. Br J Anaesth， 2009， 102（3）： 361-368. doi:10.1093/bja/aen381 |
| [23] | SOEJIMA T， UEDA K， HASEGAWA S， et al. Change in cerebral circulation during the induction of anesthesia with remimazolam ［J］. J Anesth， 2023， 37（1）： 92-96. doi:10.1007/s00540-022-03135-7 |
| [24] | 杨成迪， 徐海龙， 李健， 等. 瑞马唑仑与丙泊酚全麻诱导对颈动脉内膜剥脱术老年患者脑氧饱和度及脑血流的影响 ［J］. 沈阳药科大学学报， 2022， 39（12）： 1515-1520. |
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