Effect of CO2 pneumoperitoneum on early cellular markers of retinal ischemia in rabbits with α-chymotrypsin–induced glaucomarid=""id=""Presented in abstract form at the annual meeting of the Soci&amp;eacute;t&amp;eacute; Fran&amp;ccedil;aise d'Anesth&amp;eacute;sie-R&amp;eacute;animation, Paris, France, September, 1999, and the annual meeting of the European Society of Anaesthesiologists, Vienna, Austria, 2000 April

Lentschener, Claude; Fredi-Reygrobellet, D.; Bouaziz, Hervé; Mazoit, Jean Xavier; Niessen, Friedrich; Benhamou, Dan

doi:10.1007/s004640000257

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…However, intraocular pressure significantly increased with PNP in the head-down position, although it remained within the diurnal range [ 143 ]. A subsequent study did not observe any differences in terms of retinal layer organization and the distribution of intracellular vimentin and actin [ 144 ].…”

Section: Discussionmentioning

confidence: 99%

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

et al. 2015

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BackgroundLaparoscopic surgery has several advantages when compared to open surgery, including faster postoperative recovery and lower pain scores. However, for laparoscopy, a pneumoperitoneum is required to create workspace between the abdominal wall and intraabdominal organs. Increased intraabdominal pressure may also have negative implications on cardiovascular, pulmonary, and intraabdominal organ functionings. To overcome these negative consequences, several trials have been performed comparing low- versus standard-pressure pneumoperitoneum.MethodsA systematic review of all randomized controlled clinical trials and observational studies comparing low- versus standard-pressure pneumoperitoneum.Results and conclusionsQuality assessment showed that the overall quality of evidence was moderate to low. Postoperative pain scores were reduced by the use of low-pressure pneumoperitoneum. With appropriate perioperative measures, the use of low-pressure pneumoperitoneum does not seem to have clinical advantages as compared to standard pressure on cardiac and pulmonary function. Although there are indications that low-pressure pneumoperitoneum is associated with less liver and kidney injury when compared to standard-pressure pneumoperitoneum, this does not seem to have clinical implications for healthy individuals. The influence of low-pressure pneumoperitoneum on adhesion formation, anastomosis healing, tumor metastasis, intraocular and intracerebral pressure, and thromboembolic complications remains uncertain, as no human clinical trials have been performed. The influence of pressure on surgical conditions and safety has not been established to date. In conclusion, the most important benefit of low-pressure pneumoperitoneum is lower postoperative pain scores, supported by a moderate quality of evidence. However, the quality of surgical conditions and safety of the use of low-pressure pneumoperitoneum need to be established, as are the values and preferences of physicians and patients regarding the potential benefits and risks. Therefore, the recommendation to use low-pressure pneumoperitoneum during laparoscopy is weak, and more studies are required.

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Section: Discussionmentioning

confidence: 99%

What is the evidence for the use of low-pressure pneumoperitoneum? A systematic review

et al. 2015

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“…This finding is similar to those in other reports. 12,13 The increase in IOP was directly related to MAP in our patients. The etiology of perioperative visual loss is thought to be directly influenced by alterations in ocular perfusion pressure from changes in MAP and to be indirectly related to IOP elevation.…”

Section: Discussionmentioning

confidence: 55%

“…Many of the studies highlighting POVL and markedly elevated IOP changes (reaching glaucomatous range) after laparoscopic surgery had been performed with steep Trendelenburg position or in prolonged procedures. 12–14,19,21,22,24,25 Mondzelewski et al 22 observed a significantly elevated IOP in patients undergoing robot-assisted laparoscopic procedures in steep Trendelenburg position compared with IOP in those undergoing laparoscopy or open procedures in a horizontal position, further highlighting the role of positioning over and above that of pneumoperitoneum in significant IOP elevations. A recent study performed among patients undergoing laparoscopic colorectal surgery showed greater IOP elevation in both eyes of patients in Trendelenburg position during the surgical procedure, but found no substantial difference between the Trendelenburg and non-Trendelenburg group when IOP was measured 48 hours after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…8–11 The pneumoperitoneum induced and maintained during laparoscopy, however, has been shown to produce significant increases in IOP that may potentially alter ocular perfusion, raising concerns about possibilities of POVL after laparoscopic surgery. 12–14 There is an increasing number of reports of significant ocular complications and POVL after laparoscopic surgery. 15–18 With this in mind, in many studies, researchers have investigated the relationship between IOP changes during laparoscopy and different anaesthetic agents employed, whereas few have investigated the role of steep Trendelenburg position on IOP changes.…”

Section: Introductionmentioning

confidence: 99%

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Intraocular Pressure Changes With Positioning During Laparoscopy

Adisa¹,

Onakpoya

Adenekan

et al. 2016

JSLS

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Background and Objectives:Pneumoperitoneum during laparoscopy can produce changes in intraocular pressure (IOP) that may be influenced by several factors. In this study, we investigated changes in IOP during laparoscopy with different positioning.Methods:We recruited adult patients without eye disease scheduled to undergo laparoscopic operation requiring a reverse Trendelenburg tilt (rTr; group A; n = 20) or Trendelenburg tilt (Tr; Group B; n = 20). IOP was measured at 7 time points (T1–T7). All procedures were performed with standardized anaesthetic protocol. Mean arterial pressure (MAP), heart rate (HR), peak and plateau airway pressure, and end-tidal carbon dioxide (ETCO2) measurements were taken at each time point.Results:Both groups were similar in age, sex, mean body mass index (BMI), duration of surgery, and preoperative IOP. A decrease in IOP was observed in both groups after induction of anaesthesia (T2), whereas induction of pneumoperitoneum produced a mild increase in IOP (T3) in both groups. The Trendelenburg tilt produced IOP elevations in 80% of patients compared to 45% after the reverse Trendelenburg tilt (P = .012). A significant IOP increase of 5 mm Hg or more was recorded in 3 (15%) patients in the Trendelenburg tilt group and in none in the reverse Trendelenburg group. At T7, IOP had returned to preoperative levels in all but 3 (15%) in the Trendelenburg and 1 (5%) in the reverse Trendelenburg group. Reversible changes were observed in the MAP, HR, ETCO2, and airway pressures in both groups.Conclusions:IOP changes induced by laparoscopy are realigned after evacuation of pneumoperitoneum. A Trendelenburg tilt however produced significant changes that may require careful patient monitoring during laparoscopic procedures.

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