Intraocular Pressure and Steep Trendelenburg During Minimally Invasive Gynecologic Surgery: Is There a Risk?

Borahay, Mostafa A.; Patel, Pooja; Walsh, Teresa M.; Tarnal, Vijay; Koutrouvelis, Aristides; Vizzeri, Gianmarco; Jennings, Kristofer; Jerig, Sean; Kılıç, Gökhan

doi:10.1016/j.jmig.2013.05.005

Cited by 30 publications

(27 citation statements)

References 16 publications

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“…There is evidence in the literature that the posture-induced increase in IOP correlates with the angle of tilt. [23] This relationship is further confirmed by comparing our measures in the 6° head-down tilt position with IOP values from independent studies in subjects undergoing non-ocular surgeries performed in a steep Trendelenburg position,[1, 3, 7] and with IOP measures under complete body inversion (e.g., headstand position in yoga-practitioners). [23, 25] Finally, Spectralis OCT showed an increase in average, temporal-inferior and nasal-inferior RNFL thickness post-bed rest.…”

Section: Discussionsupporting

confidence: 72%

Ocular Outcomes Evaluation in a 14-Day Head-Down Bed Rest Study

Taibbi¹,

Cromwell²,

Zanello³

et al. 2014

aviat space environ med

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Introduction We evaluated ocular outcomes in a 14-day head-down tilt (HDT) bed rest (BR) study designed to simulate the effects of microgravity on the human body. Methods Healthy subjects were selected using NASA standard screening procedures. Standardized NASA BR conditions were implemented (e.g., strict sleep-wake cycle, standardized diet, 24-hour-a-day BR, continuous video monitoring). Subjects maintained a 6° HDT position for 14 consecutive days. Weekly ophthalmological examinations were performed in the sitting (pre/post-BR) and HDT (in-bed phase) positions. Equivalency tests with optimal-alpha techniques evaluated pre/post-BR differences in best-corrected visual acuity (BCVA), spherical equivalent, intraocular pressure (IOP), Spectral-domain OCT retinal nerve fiber layer thickness (RNFLT), optic disc and macular parameters. Results 16 subjects (12 men and 4 women) were enrolled. Nearly all ocular outcomes were within our predefined clinically relevant thresholds following HDTBR, except near BCVA (pre/post-BR mean difference: −0.06 logMAR), spherical equivalent (−0.30 D), Tonopen XL IOP (+3.03 mmHg) and Spectralis OCT average (+1.14 μm), temporal-inferior (+1.58 μm) and nasal-inferior RNFLT (+3.48 μm). Modified Amsler grid, red dot test, confrontational visual field and color vision were within normal limits throughout. No changes were detected on stereoscopic color fundus photography. Discussion A few functional and structural changes were detected after 14-day HDTBR, notably an improved BCVA possibly due to learning effect and RNFL thickening without signs of optic disc edema. In general, 6° HDTBR determined a small non-progressive IOP elevation, which returned to baseline levels post-BR. Further studies with different BR duration and/or tilt angle are warranted to investigate microgravity-induced ophthalmological changes.

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Section: Discussionsupporting

confidence: 72%

Ocular Outcomes Evaluation in a 14-Day Head-Down Bed Rest Study

Taibbi¹,

Cromwell²,

Zanello³

et al. 2014

aviat space environ med

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“…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. 23,24 Although these studies have not clearly shown that the temporary increase in IOP and decreased OPP have any clear effect and safe thresholds on optic nerve damage, the risk still exists for vulnerable patients with coexisting glaucoma or those who are of an advanced age.…”

Section: Discussionmentioning

confidence: 99%

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

Kim

Yoo

Park

et al. 2015

Journal of Endourology

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“…(Figure 2.a), horizontal (Figure 2.b), and revere Trendelenburg (Figure 2.c).Several angles were simulated for the Trendelenburg and reverse Trendelenburg positions: 0⁰ (horizontal), 5⁰, 10⁰, 20⁰, and 30⁰, chosen according to standard surgical bed angle-range and common surgical practices for procedures requiring a non-horizontal patient position[30,31,32,33,34,35, 36, 37].---Figure 2 ---2.5. Outcome Measures The skin and fat in original HU area were analyzed for effective stresses and Lagrangian strains.…”

mentioning

confidence: 99%

Heel ulcers

Friedman

Shabshin

Gefen

2020

Innovations and Emerging Technologies in Wound Care

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Heel ulcer (HU) is the second most common type of ulcer, formed when the skin and fat that envelope the calcaneus are deformed for extended periods between the bone and a support, eventually causing structural damage to the tissues. No specific data exist regarding the invivo mechanical stress and strain thresholds for the onset and progression of HUs within clinically-relevant time periods (e.g., while anesthetized in the operation room, bed-bound in nursing homes, etc.). We used an MRI heel scan of a 72 years-old male with a clearly demonstrated deep tissue injury at the right heel, to develop a three-dimensional finite element model of the heel which include the calcaneal bone, subcutaneous fat, insertion and distal region of the Achilles tendon, and the skin. Biomechanical properties of all tissues were adopted from the literature. A pre-injury anatomy was simulated using healthy-tissue mechanical attributes. Thresholds of the mechanical loads which led to the onset and progression of HU were accessed by back-calculating the mechanical conditions in the wound, caused by the foot weight, as it is not expected to significantly change during the injury-relevant time frame. Shear due to support inclination and foot weight were simulated by displacing the superior surface of the calcaneus downward and horizontally. Von-Mises stress and Lagrangian strain injury thresholds were offered, along with compressive to tensile proportions of the total strain. The influence of shear stress, foot weight, and bed-angle on the thresholds was analyzed. Strain energy density was examined as a predictor for ulcer formation.

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Intraocular Pressure and Steep Trendelenburg During Minimally Invasive Gynecologic Surgery: Is There a Risk?

Cited by 30 publications

References 16 publications

Ocular Outcomes Evaluation in a 14-Day Head-Down Bed Rest Study

Ocular Outcomes Evaluation in a 14-Day Head-Down Bed Rest Study

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

Heel ulcers

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