Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45° Trendelenburg position

Abstract

BackgroundTo evaluate changes in intraocular pressure (IOP) and intracerebral pressure (ICP) reflected by the optic nerve sheath diameter (ONSD) in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) in permanent 45° steep Trendelenburg position (STP).MethodsFifty-one patients undergoing RALP under a standardised anaesthesia. IOP was perioperatively measured in awake patients (T0) and IOP and ONSD 20 min after induction of anaesthesia (T1), after insufflation of the abdomen in supine position (T2), after 30 min in STP (T3), when controlling Santorini’s plexus in STP (T4) and before awakening while supine (T5). We investigated the influence of respiratory and circulatory parameters as well as patient-specific and time-dependent factors on IOP and ONSD.ResultsAverage IOP values (mmHg) were T0 = 19.9, T1 = 15.9, T2 = 20.1, T3 = 30.7, T4 = 33.9 and T5 = 21.8. IOP was 14.0 ± 7.47 mmHg (mean ± SD) higher at T4 than T0 (p = 0.013). Univariate mixed effects models showed peak inspiratory pressure (PIP) and mean arterial blood pressure (MAP) to be significant predictors for IOP increase. Mean ONSD values (mm) were T1 = 5.88, T2 = 6.08, T3 = 6.07, T4 = 6.04 and T5 = 5.96. The ONSD remained permanently >6.0 mm during RALP. Patients aged <63 years showed a 0.21 mm wider ONSD on average (p = 0.017) and greater variations in diameter than older patients.ConclusionsThe combination of STP and capnoperitoneum during RALP has a pronounced influence on IOP and, to a lesser degree, on ICP. IOP is directly correlated with increasing PIP and MAP. IOP doubled and the ONSD rose to values indicating increased intracranial pressure. Differences in the ONSD were age-related, showing higher output values as well as better autoregulation and compliance in STP for patients aged <63 years. Despite several ocular changes during RALP, visual function was not significantly impaired postoperatively.Trial registration Z-2014-0387-6. Registered 8 July 2014.

Prospective evaluation of visual function in patients with ocular diseases after robot‐assisted laparoscopic prostatectomy

“…To the best of our knowledge, the present study was the first and largest prospective study to evaluate IOP and visual field sensitivity during RALP in the patients with ocular diseases. We showed that IOP significantly increased during TP in RALP in a time‐dependent manner, as previously described . Regarding the degree of elevation of IOP, at 3 h after TP, glaucomatous patients showed significantly lower IOP change, partly because of perioperative ophthalmic drops to maintain IOP within the normal range.…”

“…We showed that IOP significantly increased during TP in RALP in a time-dependent manner, as previously described. [5][6][7][8]13,20 Regarding the degree of elevation of IOP, at 3 h after TP, glaucomatous patients showed significantly lower IOP change, partly because of perioperative ophthalmic drops to maintain IOP within the normal range. At 7 days after RALP, IOP returned to near preoperative levels, as previously described.…”

“…Recently, several prospective clinical studies have been carried out to evaluate the effects on visual function in patients undergoing RALP . However, most studies excluded patients with pre‐existing ocular diseases, and included healthy patients who were favorable for RALP.…”

“…3,4 Recently, several prospective clinical studies have been carried out to evaluate the effects on visual function in patients undergoing RALP. [5][6][7][8][9][10][11][12][13] However, most studies excluded patients with pre-existing ocular diseases, and included healthy patients who were favorable for RALP. Thus far, there has been no prospective assessment regarding RALP for patients with ocular diseases, except for a case report; a glaucomatous patient who underwent RALP without any severe ocular damage was reported on, and how to monitor and manage elevated IOP during RALP was described.…”

Postanesthesia care unit delirium following robot‐assisted vs open retropubic radical prostatectomy: A prospective observational study

“…Observational studies have reported impairment of cerebrovascular autoregulation and increased intracranial pressure during surgery in the Trendelenburg position with capnoperitoneum . Ischemic optic neuropathy resulting from intracranial pressure elevation has been observed in single cases during Trendelenburg position …”