Effect Of Different Neuromuscular Blockade On The Optic Nerve Sheath Diameter In Patients Undergoing Laparoscopic Cholecystectomy Combined With Common Bile Duct Exploration

Objective:By observing the changes of optic nerve sheath diameter at different time points during laparoscopic cholecystectomy combined with common bile duct exploration under different neuromuscular blockade,to explore the effect of different neuromuscular blockade on intracranial pressure in patients with pneumoperitoneum,so as to provide a new idea for brain protection in laparoscopic surgery.Methods:Sixty patients undergoing laparoscopic cholecystectomy combined with common bile duct exploration under general anesthesia were randomly divided into deep neuromuscular blockade group（n=30）and moderate neuromuscular blockade group（n=30）.TOF-Watch muscle relaxation monitor was used to monitor the degree of neuromuscular blockade during the operation.the TOF count in deep neuromuscular blockade group was maintained at 0 and the PTC count was 1-2,and the TOF count in moderate neuromuscular blockade group was maintained at 1-2.The ONSD、MAP、HR and CVP were recorded before induction（T₀）,supine horizontal position before skin incision（T₁）,30min supine horizontal position after pneumoperitoneum（T₂）,1h supine horizontal position after pneumoperitoneum（T₃）,10min supine horizontal position after deflation（T₄）,before leaving the operating room（T₅）,ETCO₂、Pa CO₂、Ppeak were recorded at T₁-T₄,and the recovery time of TOFr0.9、MMSE score before operation 1 day and after operation 1 day、the incidence of nausea、vomiting、headache and other complications after operation 1 day also were recorded.Results:1.There was no significant difference in MAP and HR between the two groups at different time points（P>0.05）.2.There was no significant difference in Ppeak between the two groups at different time points（P>0.05）.Compared with T₁,Ppeak was significantly higher in both groups during T₂-T₃（P<0.05）.3.There was no significant difference in ETCO₂and Pa CO₂between the two groups at different time points（P>0.05）.Compared with T₁,ETCO₂and Pa CO₂were significantly increased in both groups during T₂-T₄（P<0.05）.Compared with T₂,the values of ETCO₂and Pa CO₂were also significantly increased at T₃（P<0.05）and decreased at T₄,but still higher than those at T₁（P<0.05）.4.Comparing the CVP of the two groups at different time points,compared with T₀,there was no significant difference in CVP at T₁between the two groups（P>0.05）,but it was significantly higher at T₂-T₅（P<0.05）.There was no significant difference in CVP between the two groups at T₀and T₁（P>0.05）.The CVP in deep neuromuscular blockade group at T₂-T₃was significantly lower than that in moderate neuromuscular blockade group（P<0.05）,and there was no significant difference at T₄and T₅（P>0.05）.5.Comparing the ONSD of the two groups at different time points,compared with T₀,the ONSD of the two groups of T₂-T₅patients was significantly higher than that of the T₀group（P<0.05）.There was no significant difference in ONSD between the two groups at T₀and T₁（P>0.05）,but the ONSD in the deep neuromuscular blockade group was significantly lower than that in the moderate neuromuscular blockade group at T₂-T₅（P<0.05）.6.The recovery time of TOFr0.9 in deep neuromuscular blockade group was longer than that in moderate neuromuscular blockade group（P<0.05）,but the value of TOF in 5min of both groups was more than 90%.7.There was no significant difference in the MMSE score and the incidence of postoperative nausea,vomiting and headache between the two groups before operation and 1 day after operation（P<0.05）.Conclusion:In laparoscopic cholecystectomy combined with common bile duct exploration,pneumoperitoneum will lead to a significant increase in ONSD.Compared with moderate neuromuscular blockade group,deep neuromuscular blockade can alleviate the increase of ONSD to some extent,which provides a new idea for brain protection in laparoscopic surgery.