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

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.

A Comparison of the Responses to Diode and Argon Laser Irradiation of the Iris in Rabbits

We compared the effects of diode laser (DL) irradiation of the iris with those of argon laser (AL). Histopathologic examination of laser-induced lesion, measurements of aqueous flare and prostaglandin (PG) E2 were performed. DL was applied in one eye of each animal and the fellow eye received ALwith the same parameters in 49 pigmented rabbits. At 1 hour after irradiation, the mean flare count was higher in the DL-treated eyes than in AL-treated eyes(p0.05). On histopathologic examinations, iris defect by DL was wider and shallower than that by AL. The extent of coagulation of the iris tissue was more extensive in the DL-irradiated iris. Our results suggest that the DL irradiation may be more harmful to the blood-aqueous barrier and iris tissue than AL. Further development of the laser equipment or the treatment regimen for diode laser iridotomy may be necessary.