Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep Trendelenburg position

Abstract

Intraocular pressure increases after pneumoperitoneum and the steep Trendelenburg position are established. This increase is less with propofol than with sevoflurane anesthesia. This trial was registered at ClinicalTrials.gov: NCT01744262.

The Effect of Dexmedetomidine on Intraocular Pressure Increase in Patients During Robot-Assisted Laparoscopic Radical Prostatectomy in the Steep Trendelenburg Position

“…IOP was measured repeatedly thrice for each eye at 11 different time points; the median value was used as a representative value in the analysis with a linear mixed model. 10 The OPP, MBP, HR, ETCO 2 , CVP, peak inspiratory pressure (PIP), BIS, and end-tidal sevoflurane concentration were analyzed in the same way as IOP. Differences over time were compared between the groups using a group-by-time interaction.…”

“…As in previous studies, a gradual increase in IOP was observed with a pneumoperitoneum in the ST position. 6,10 The majority of the patients were elderly and even more vulnerable to an eye injury from the increase in IOP. 13,21,22 There have been a number of reports regarding the impact of a sudden increase in IOP during surgery on optic nerve damage.…”

“…Sample size calculations were based on a previous study, 10 in which we found that the mean -SD difference in IOP at 30 minutes after CO 2 pneumoperitoneum in the ST position with propofol-based total intravenous (IV) anesthesia was 19.97 -3.76 mm Hg, whereas that for sevoflurane anesthesia was 23.5 -4.32 mm Hg. To detect a 3.5 mm Hg difference in IOP between the two groups (two-sided a 0.05, power 90%), 29 patients were needed in each group.…”

“…8 This position may cause severe ophthalmic complications owing to increased IOP and decreased OPP. [9][10][11] Recently, serious optic damage has been reported after robot-or laparoscopic-assisted radical prostatectomy. 12 In addition, our recent study demonstrated that IOP rises consistently during RALRP.…”

“…12 In addition, our recent study demonstrated that IOP rises consistently during RALRP. 10 Moreover, most patients undergoing RALRP are elderly patients who are more vulnerable to ocular complications. 13 Therefore, a strategy for reducing the IOP increase during surgery is important for preventing postoperative ophthalmic complications.…”