Abstract：
BACKGROUND: Optic nerve sheath diameter (ONSD) reflects intracranial pressure and is increased in pre-eclampsia. Administrating a significant volume of epidural solution into the epidural space can potentially increase ONSD. We investigated the impact of epidural local anesthetic injection on ONSD in patients with pre-eclampsia.
METHODS: Patients with pre-eclampsia (n=11) and normotensive pregnant women (n=11) received de novo epidural anesthesia for cesarean delivery. We administered 21 mL of an epidural solution containing 2% lidocaine and 50 μg fentanyl into the lumbar epidural space in incremental doses. ONSD was measured at baseline, 3, 10, and 20 min after completing the epidural injection, after delivery, and at the end of surgery. Primary outcome was the change in ONSD from baseline to 3 min after epidural injection in patients with pre-eclampsia and normotensive pregnant women. Serial changes in the ONSD were analyzed using a linear mixed model.
RESULTS: At baseline and 3 min after epidural drug injection, ONSD was significantly larger in patients with pre-eclampsia than in normotensive mothers (5.7 vs 4.1 mm, p=0.001 and 5.4 vs 4.1 mm, p<0.001, respectively). However, there were no significant changes in ONSD at 3 min after injection from baseline in either group (p>0.999). Linear mixed model demonstrated that ONSD did not change after epidural anesthesia in either group (p=0.279 and p=0.347, respectively).
CONCLUSIONS: Despite a higher baseline ONSD in pre-eclampsia, epidural anesthesia did not further increase ONSD. Our findings indicate that epidural anesthesia can be safely administered in patients with pre-eclampsia at risk of increased intracranial pressure, without other intracranial pathology.
BACKGROUND: NCT04095832.
METHODS: Patients with pre-eclampsia (n=11) and normotensive pregnant women (n=11) received de novo epidural anesthesia for cesarean delivery. We administered 21 mL of an epidural solution containing 2% lidocaine and 50 μg fentanyl into the lumbar epidural space in incremental doses. ONSD was measured at baseline, 3, 10, and 20 min after completing the epidural injection, after delivery, and at the end of surgery. Primary outcome was the change in ONSD from baseline to 3 min after epidural injection in patients with pre-eclampsia and normotensive pregnant women. Serial changes in the ONSD were analyzed using a linear mixed model.
RESULTS: At baseline and 3 min after epidural drug injection, ONSD was significantly larger in patients with pre-eclampsia than in normotensive mothers (5.7 vs 4.1 mm, p=0.001 and 5.4 vs 4.1 mm, p<0.001, respectively). However, there were no significant changes in ONSD at 3 min after injection from baseline in either group (p>0.999). Linear mixed model demonstrated that ONSD did not change after epidural anesthesia in either group (p=0.279 and p=0.347, respectively).
CONCLUSIONS: Despite a higher baseline ONSD in pre-eclampsia, epidural anesthesia did not further increase ONSD. Our findings indicate that epidural anesthesia can be safely administered in patients with pre-eclampsia at risk of increased intracranial pressure, without other intracranial pathology.
BACKGROUND: NCT04095832.
摘要：
背景：视神经鞘直径（ONSD）反映了颅内压，并且在先兆子痫中增加。将大量的硬膜外溶液注入硬膜外腔可能会增加ONSD。我们研究了硬膜外局部麻醉药注射对先兆子痫患者ONSD的影响。
方法：先兆子痫（n=11）和血压正常的孕妇（n=11）接受硬膜外麻醉剖宫产。我们将21mL含2％利多卡因和50μg芬太尼的硬膜外溶液以递增剂量的方式注入腰椎硬膜外腔。在基线测量ONSD，完成硬膜外注射后3、10和20分钟，交货后,在手术结束时。主要结果是先兆子痫和血压正常的孕妇硬膜外注射后3分钟ONSD的变化。使用线性混合模型分析了ONSD的系列变化。
结果：在基线和硬膜外药物注射后3分钟，先兆子痫患者的ONSD明显大于血压正常的母亲（5.7vs4.1mm，p=0.001和5.4vs4.1毫米，p分别<0.001)。然而,两组注射后3分钟的ONSD与基线相比均无显著变化(p>0.999).线性混合模型表明，两组患者硬膜外麻醉后ONSD均无变化（分别为p=0.279和p=0.347）。
结论：尽管先兆子痫患者的基线ONSD较高，硬膜外麻醉并未进一步增加ONSD.我们的研究结果表明，硬膜外麻醉可以安全地用于有颅内压升高风险的先兆子痫患者，没有其他颅内病理。
背景：NCT04095832。
方法：先兆子痫（n=11）和血压正常的孕妇（n=11）接受硬膜外麻醉剖宫产。我们将21mL含2％利多卡因和50μg芬太尼的硬膜外溶液以递增剂量的方式注入腰椎硬膜外腔。在基线测量ONSD，完成硬膜外注射后3、10和20分钟，交货后,在手术结束时。主要结果是先兆子痫和血压正常的孕妇硬膜外注射后3分钟ONSD的变化。使用线性混合模型分析了ONSD的系列变化。
结果：在基线和硬膜外药物注射后3分钟，先兆子痫患者的ONSD明显大于血压正常的母亲（5.7vs4.1mm，p=0.001和5.4vs4.1毫米，p分别<0.001)。然而,两组注射后3分钟的ONSD与基线相比均无显著变化(p>0.999).线性混合模型表明，两组患者硬膜外麻醉后ONSD均无变化（分别为p=0.279和p=0.347）。
结论：尽管先兆子痫患者的基线ONSD较高，硬膜外麻醉并未进一步增加ONSD.我们的研究结果表明，硬膜外麻醉可以安全地用于有颅内压升高风险的先兆子痫患者，没有其他颅内病理。
背景：NCT04095832。
