Comparison of the Effects of Propofol and Sevoflurane Anesthesia on Optic Nerve Sheath Diameter in Robot-Assisted Laparoscopic Gynecology Surgery: A Randomized Controlled Trial

Kim, Jung Eun; Koh, Seong Yoon; Jun, In-Jung

doi:10.3390/jcm11082161

Cited by 8 publications

(7 citation statements)

References 31 publications

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“…This discrepancy is probably due to the fact that our study enrolled mostly elderly male patients, and female patients vulnerable to PONV. In Kim et al study [26] 42 female patients undergoing robot-assisted laparoscopic surgery concluded the significant increase in the ONSD of patients with a smaller ONSD increase during propofol anesthesia compared to sevoflurane anesthesia. Two patients from the Sevoflurane group experienced PONV, but this number was not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Assessment of Optic Nerve Sheath Diameter during Surgery in the Trendelenburg Position

Skladzien,

Kurdziel,

Przydacz

et al. 2023

Preprint

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Background Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) is helpful in the assessment of intracranial pressure. The aim of this study was to determine whether the Trendelenburg position during laparoscopic urological surgery changed the ONSD and whether changes correlated with postoperative complications. Methods In this prospective study, we measured ONSD before patients were placed in the Trendelenburg position. Then the Trendelenburg position was established by tilting the operating table to 20-25 degrees. After surgery, the patients were placed in a horizontal position, and the second measurement of ONSD was obtained. Results The study included 69 patients. The average preoperative ONSD in the right eye was 5.8 ± 0.7 mm and 5.8 ± 0.8 mm in the left eye. The average postoperative ONSD in the right eye was 6.6 ± 0.8 mm and 6.6 ± 0.7 mm in the left eye. The differences between postoperative and preoperative values in the right and left eyes were statistically significant (p <0.000001). ONSD increases above the norm did not correlate with the incidence of postoperative nausea (p = 0.94), delirium (p = 0.81), or the time to patient awakening (p = 0.29). Conclusion ONSD increased in patients who underwent surgical procedures performed in the Trendelenburg position, but the increase did not correlate with postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Assessment of Optic Nerve Sheath Diameter during Surgery in the Trendelenburg Position

Skladzien,

Kurdziel,

Przydacz

et al. 2023

Preprint

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“…40 min after induction of pneumoperitoneum in TP, ONSD increased significantly in the sevoflurane group compared to the propofol group. As a result, in patients undergoing robot-assisted surgery, anaesthesia with propofol produced lower increases in ONSD compared to anaesthesia with sevoflurane [ 52 ].…”

Section: Postoperative Visual Defectsmentioning

confidence: 99%

“…In recent years, many authors have investigated the role of ONSD increases in identifying how increased IOP in TP affects ICP. Many authors examined the role of Ultrasonographic measurement of ONSD in identifying ICP changes during STP, confirming that ONSD increases in TP with pneumoperitoneum, as STP and pneumoperitoneum have a detrimental effect on cerebral hemodynamic physiology [ 49 , 51 , 52 , 53 ].…”

Section: Implications For Practicementioning

confidence: 99%

The Impact of Steep Trendelenburg Position on Intraocular Pressure

Ripa

Schipa

Kopsacheilis

et al. 2022

JCM

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Intraocular pressure occurring during the Trendelenburg position may be a risk for postoperative visual loss and other ocular complications. Intraocular pressure (IOP) higher than 21 mmHg poses a risk for ocular impairment causing several conditions such as glaucoma, detached retina, and postoperative vision loss. Many factors might play a role in IOP increase, like peak expiratory pressure (PIP), mean arterial blood pressure (MAP), end-tidal CO2 (ETCO2) and surgical duration and some others (anaesthetic and neuromuscular blockade depth) contribute by reducing IOP during procedures requiring both pneumoperitoneum and steep Trendelenburg position (25–45° head-down tilt). Despite transient visual field loss after surgery, no signs of ischemia or changes to the retinal nerve fibre layer (RNFL) have been shown after surgery. Over the years, several studies have been conducted to control and prevent IOPs intraoperative increase. Multiple strategies have been proposed by different authors over the years to reduce IOP during laparoscopic procedures, especially those involving steep Trendelenburg positions such as robot-assisted laparoscopic prostatectomy (RALP), and abdominal and pelvic procedures. These strategies included both positional and pharmacological strategies.

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“…For patients who have significant medical comorbidities, it is necessary to communicate with different medical teams to optimize their conditions, and discuss with the anesthetists on the use of anesthesia. For example, patients with hypertension, stroke or brain tumor may better receive propofol instead of sevoflurane anesthesia as the former caused less increase in ICP and optic nerve sheath diameter [60]. Special attention should be paid to patients with extreme body mass index (BMI) or big uterus and is discussed as below.…”

Section: Preventive Measures At Set-upmentioning

confidence: 99%

Tips for set-up to prevent complications in robotic gynecologic cancer surgery

Tse¹

2022

Gyne Robot Surg

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Robotic surgery (RS) is a breakthrough in gynecologic oncology in the past decade and it is now part of the routine in many centers. Although there is a concern about the oncological outcomes after RS in cervical cancer, it is proven to be safe and effective in endometrial cancer. However, RS has some drawbacks such as the loss of tactile feedback. Complications can therefore occur, and are usually multi-factorial. These can be related to the nature of the operations, the physical fitness of the patients, the control and choice of the devices, and more importantly, the experience and knowledge of the surgical team. To minimise the risk of complications, we need to understand the limitations of RS and have a proper set-up of the operations. It is important to anticipate these potential complications before and during the operations. And a careful setup of the operations, including the instrument set-up, patients’ positioning, port placement, and communication with the anesthetists and surgical team, are crucial in ensuring the safety and success of robotic surgery. In this article, different complications and their preventive measures at set-up were discussed.

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Comparison of the Effects of Propofol and Sevoflurane Anesthesia on Optic Nerve Sheath Diameter in Robot-Assisted Laparoscopic Gynecology Surgery: A Randomized Controlled Trial

Cited by 8 publications

References 31 publications

Ultrasound Assessment of Optic Nerve Sheath Diameter during Surgery in the Trendelenburg Position

Ultrasound Assessment of Optic Nerve Sheath Diameter during Surgery in the Trendelenburg Position

The Impact of Steep Trendelenburg Position on Intraocular Pressure

Tips for set-up to prevent complications in robotic gynecologic cancer surgery

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