LOMBER DİSK CERRAHİSİNDE GENEL VE SPİNAL ANESTEZİNİN INTRAOKULER BASINÇ ÜZERİNE ETKİLERİNİN KARŞILAŞTIRILMASI

Öz

Perioperatif görme kaybı nadir fakat yıkıcı sonuçları olan bir komplikasyondur. Lomber diskektomi gibi pron pozisyonda gerçekleştirilen ameliyatlarda sıklığı diğer cerrahilerin 4 katına kadar çıkabilmektedir. En sık nedeni posterior iskemik optik nöropati olarak bildirilse de pron pozisyonun göz içi basıncını arttırması da bir neden olabilir. Çalışmamızda pron pozisyonda gerçekleştirilen lomber diskektomilerde genel ve spinal anestezinin intraoküler basınç üzerine farklı etki oluşturup oluşturmayacakları araştırıldı. Elektif koşullarda lomber disk herni cerrahisi planlanan 18-65yaş, ASA1-2 risk grubunda hastalar çalışmaya alındı ve Grup GA (Genel Anestezi) ve Grup SA (Spinal Anestezi) olarak ayrıldı. Hastaların demografik ve operatif verileri kaydedildi. İntraoküler basınç ölçümleri preoperatif supin pozisyonda ve postoperatif pron pozisyon sonrası supin pozisyonun 5.dakikasında ölçüldü. 120 hasta çalışmaya alındı, 77 hastanın verileri analiz edildi. Grup GA’da postoperatif intraoküler basınç değerlerinin preoperatif elde edilen değerlere göre yükseldiği (her iki göz için p<0.001); Grup SA’da, pre ve postoperatif intraoküler basınç değerlerinin benzer olduğu saptandı (p=0.727 ve 0.699).Arteriyel kan basıncı ve kalp tepe atımı değerlerinde Grup GA’da ekstübasyonla birlikte ani bir artış gözlendi. Demografik veriler ve intraoperatif ölçümlerin incelendiği regresyon analizinde sadece vücut kitle indeksi ile her iki intraoküler basınç değeri arasında doğrusal bir ilişki saptandı. Çalışmamızda hemodinaminin stabil seyrettiği, 2 saatten kısa süren disk hernisi operasyonları incelendi. İntraoküler basıncın genel anestezi sonrası anlamlı düzeyde yükseldiği, spinal anestezi sonrası ise değişmediği saptandı. İntraoperatif dönemde intraoküler basınç artıştan endişe ediliyorsa, spinal anestezinin tercih edilmesinin daha uygun olacağı kanaatindeyiz. Bu öneri hemodinaminin minimal etkilendiği, kanama beklenmeyen lomber diskektomi vakalarına yöneliktir. Vücut kitle indeksi yüksek olan hastalarda bu artışın daha yüksek olabileceği göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• İntraoküler Basınç
• Pron Pozisyon
• Lomber Disk Hernisi
• Genel Anestezi
• Spinal Anestezi

COMPARISON OF THE EFFECTS OF GENERAL AND SPINAL ANESTHESIA ON INTROCULAR PRESSURE IN THE LUMBAR DISC SURGERY

Öz

Preoperative vision loss is a rare but devastating complication. The frequency of occurrence after operations performed in the prone position, such as lumbar discectomy, can be up to 4 times that of other surgeries. Although the most common cause is reported as posterior ischemic optic neuropathy, increased intraocular pressure from the prone position may also be a cause. In our study, it was investigated whether general and spinal anesthesia would have different effects on intraocular pressure in lumbar discectomies performed in the prone position. Following approval of Local Ethics Committee, Patients aged 18-65 years, ASA1-2 risk group who were scheduled for lumbar disc hernia surgery under elective conditions were included in the study and divided into Group GA (General Anesthesia) and Group SA (Spinal Anesthesia). Demographic and operative data of the patients were recorded. Intraocular pressure measurements were performed in the preoperative supine position and It was measured at the 5th minute of the supine position after the postoperative prone position. 120 patients were included in the study, data of 77 patients were analyzed. In Group GA, postoperative intraocular pressure values increased compared to the values obtained preoperatively (p<0.001 for both eyes); Pre- and postoperative intraocular pressure values were found to be similar in Group SA (p=0.727 and 0.699). A sudden increase in arterial blood pressure and heart rate values was observed in GroupGA with extubation. In the regression analysis examining demographic data and intraoperative measurements, a linear relationship was found between only body mass index and both intraocular pressure values. In our study, disc herniation operations lasting less than 2 hours, with stable hemodynamics, were examined. It was determined that the intraocular pressure increased significantly after general anesthesia and did not change after spinal anesthesia. If there is concern about an increase in intraocular pressure during the intraoperative period, we believe that spinal anesthesia should be preferred. This recommendation is for lumbar discectomy cases where hemodynamics is minimally affected and bleeding is not expected. It should be considered that this increase may be higher in patients with a high body mass index.

Anahtar Kelimeler

• Intraocular pressure
• Prone position
• Lumbar discectomy
• General anesthesia
• Spinal anesthesia

Kaynakça

1. Amorim Correa JL, Acioly MA. The Enigma of Orbital Compartment Syndrome After Lumbar Spine Surgery in the Prone Position: Case Report and Literature Review. World neurosurgery. 2018;110:309-14.
2. Cheng MA, Todorov A, Tempelhoff R, McHugh T, Crowder CM, Lauryssen C. The effect of prone positioning on intraocular pressure in anesthetized patients. Anesthesiology. 2001;95(6):1351-5.
3. Epstein NE. How to avoid perioperative visual loss following prone spinal surgery. Surg Neurol Int. 2016;7(Suppl 13):S328-30.
4. Harten JM, Boyne I, Hannah P, Varveris D, Brown A. Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section. Anaesthesia. 2005;60(4):348-53.
5. Hassanein A, Zekrly J, Moharram H. Effect of lidocaine Instillation into Endotracheal Tube on Intraocular Pressure during Extubation. Journal of Anesthesia & Clinical Research. 2015;6:559.
6. Hatipoglu S, Abdullayev R, Kucukebe OB, Guler M, Hatipoglu F, Celik B, et al. Intraocular Pressure Changes After Spinal Anesthesia--Acute and Subacute Effects on Surgery Patients. Adv Clin Exp Med. 2015;24(5):857-61.
7. Ho VT, Newman NJ, Song S, Ksiazek S, Roth S. Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol. 2005;17(1):38-44.
8. Leibovitch I, Casson R, Laforest C, Selva D. Ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. Ophthalmology. 2006;113(1):105-8.

9. Lyzohub MV, Georgiyants MA, Lyzohub KI, Volkova JV, Dmytriiev DV, Dmytriiev KD. influence of anesthesia type on intraocular pressure during spine surgery in prone position. Wiadomosci lekarskie (Warsaw, Poland : 1960). 2020;73(1):104-6.
10. Newman NJ. Perioperative visual loss after nonocular surgeries. American journal of ophthalmology. 2008;145(4):604-10.
11. Okafor KC, Brandt JD. Measuring intraocular pressure. Current opinion in ophthalmology. 2015;26(2):103-9.
12. Panon N, Luangsawang K, Rugaber C, Tongchit T, Thongsepee N, Cheaha D, et al. Correlation between body mass index and ocular parameters. Clin Ophthalmol. 2019;13:763-9.
13. Park B, Choi SW, Han S, Youm JY, Lim JW, Kwon HJ. Cushing Syndrome: A Potential Risk of Bilateral Postoperative Ischemic Optic Neuropathy after Lumbar Fusion. Korean J Neurotrauma. 2019;15(2):221-6.
14. Pierce JT, Kositratna G, Attiah MA, Kallan MJ, Koenigsberg R, Syre P, et al. Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients. Local Reg Anesth. 2017;10:91-8.
15. Pinar HU, Kasdogan ZEA, Basaran B, Coven I, Karaca O, Dogan R. The effect of spinal versus general anesthesia on intraocular pressure in lumbar disc surgery in the prone position: A randomized, controlled clinical trial. J Clin Anesth. 2018;46:54-8.
16. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116(1):15-24.
17. SA VANW. Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery. International journal of spine surgery. 2020;14(2):195-208.
18. Şekeryapan B BH, Tomak Y, Türkyılmaz K, Öner V, Durmuş M. Acute Effect of Spinal Anesthesia on Intraocular Pressure. Journal of Glaucoma-Cataract. 2013;8:185-8.
19. Stambough JL, Dolan D, Werner R, Godfrey E. Ophthalmologic complications associated with prone positioning in spine surgery. J Am Acad Orthop Surg. 2007;15(3):156-65.
20. Wang MY, Brewer R, Sadun AA. Posterior ischemic optic neuropathy: Perioperative risk factors. Taiwan journal of ophthalmology. 2020;10(3):167-73.
21. Yagan O, Karakahya RH, Tas N, Canakci E, Hanci V, Yurtlu BS. Intraocular pressure changes associated with tracheal extubation: Comparison of sugammadex with conventional reversal of neuromuscular blockade. JPMA The Journal of the Pakistan Medical Association. 2015;65(11):1219-25.