Effect of controlled hypotenston with nitroglycerin on intraocular pressure during gynecological laparoscoplc surgery / 中华麻醉学杂志

ABSTRACT

Objective To investigate the effect of controlled hypotension with nitroglycerin on intraocular pressure(IOP)during gynecological laparoscopic surgery.Methods Forty ASA Ⅰ or Ⅱ patients,aged 25-55 yr,weighing 55-70 kg,undergoing gynecological laparoscopic surgery,were randomly divided into 2 groups(n =20 each)control group(group C)and controlled hypotension with nitroglycerin group(group N).Anesthesia was induced with iv injection of midaaolam 0.1 mg/kg,fentanyl 3 μg/kg,vecuronium 0.1 mg/kg and etomidate 0.3 mg/kg and maintained with iv infusion of propofol at 8 mg· kg-1 · h-1 and vecuronium at 0.1 mg· kg 1 · h-1.Additional fentanyl 2 μg/kg was injected intravenously at 3 min before the starting of surgery.The patients was tracheal intuhated and mechanically ventilation.PETCO2 was maintained at 35-40 mm Hg.BIS value was maintained at 50-60.Controlled hypotension was induced by infusion of nitroglycerin at 2-4 μg· kg-1 · min-1 after the starting of surgery.CVP was maintained at 12-14 cm H2 O.Controlled hypotension was stopped at the end of operation.IOP and CVP were recorded before induction(To),at 3 min after tracheal intubation(T1),at 10,30,60,90 and 120 m in of pneumoperitoneum(T2-6)and at 10 min after pneumoperitoneum(T7).Intraocular hypertension(IOP ＞ 21mm Hg)was also recorded.Results Compared with group C,IOP at T3-6 and CVP at T2-6 were significantly decreased,and the incidence of intraocular hypertension was also decreased in group N(P ＜ 0.01).Conclusion Controlled hypotesion with nitroglycerin can prevent the intraocular hypertension effectively during gynecological laparoscopic surgery.