Intra‐ocular pressure changes during gynaecological laparoscopy

Aims and Objectives:Laparoscopic surgery is the choice for gynaecological surgery these days, but pneumoperitoneum (PNO) and trendelenburg position increase the intraocular pressure (IOP) leading to decrease in perfusion of retina and at times the significant risk of ischemic retinopathy. Our present aim is to find out the suitable combination of induction and maintenance agent for combating the increase in IOP by PNO, lithotomy and trendelenburg position, and to study the changes in IOP at different time points and positions in gynaecological laparoscopic procedures.Patients and methods:After taking permission from the Ethical Committee 120 female patients of ASA grade 1 and II were divided arbitrarily in four groups each comprising 30 patients. In group A and B induction was done with propofol 2.5 mg/kg given IV and in group C and D induction was done with thiopentone 5 mg/kg given IV. Atracurium 0.5 mg/kg IV was used as neuromuscular blocking agent (NMBA).Laryngeal mask airway (LMA) was inserted in all the cases and patients were ventilated with Bain's circuit. Maintenance of anesthesia was done with total intra venous anesthesia (TIVA) with propofol and100% oxygen in group A and C. In group B and D maintenance was done with 1% isoflurane with oxygen (O2) and nitrous oxide (N2O) in the ratio of 40:60. Changes in IOP, heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) were measured. Baseline readings were taken initially and then 2 min after premedication, 1 min after LMA insertion, 1 min after PNO with lithotomy position, 5 min after 20° head down tilt and PNO in situ and 2 min after exsufflation of PNO with supine horizontal position.Results and Conclusion:To mitigate increase in IOP during gynaecological laparoscopic surgeries, propofol, and propofol TIVA (Group A) proved to be the best option. Propofol and isoflurane (Group B) thiopentone and propofol TIVA (Group C) were not as effective as group A. However, induction with thiopentone and maintenance with isoflurane (Group D) were not effective at all.

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“…They found that IOP was significantly below the baseline value and never exceeded the pre-induction value. [91011]…”

Section: Discussionmentioning

confidence: 99%

A comparative study of four combinations of anesthetic drugs for assessing the intraocular pressure changes during gynaecological laparoscopic procedures

et al. 2013

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“…Indeed, an increased intraperitoneal pressure of 15 mmHg under GA did not adversely affect IOP in women with no preexisting eye disease because the decrease in IOP caused by GA compensated for the increase in IOP caused by the head-down position [7]. Conversely, in rabbits with ␣-chymotrypsin-induced glaucoma in one eye, IOP of both glaucomatous and control eyes increased significantly when an increased intraperitoneal pressure of Յ15 mmHg was combined with the headdown position [8].…”

Section: Discussionmentioning

confidence: 99%

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 Société Française d'Anesthésie-Réanimation, Paris, France, September, 1999, and the annual meeting of the European Society of Anaesthesiologists, Vienna, Austria, 2000 April

Lentschener

Fredi-Reygrobellet

Bouaziz³

et al. 2000

Surg Endosc

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“…Lentschener et al 21 . found that IOP decreased significantly after induction of anaesthesia, remained unchanged after pneumoperitoneum had been established and increased with head‐down position but did not significantly change.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Therefore, concern may be raised that laparoscopic surgery could contribute to early intraoperative aggravation of pre-existing eye disease in a certain subset of patients. 6 In the present study, we investigated IOP at each step of gynaecological laparoscopy carried out under general anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

The effect of pneumoperitoneum and head‐down position on intraocular pressure

et al. 2002

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Objective Increased intraperitoneal pressure and head‐down position are associated with physiological changes including alterations of intraocular pressure. Subjects We investigated haemodynamic, respiratory and intraocular pressure changes at each phase of gynaecological laparoscopy, in 20 women of ASA I status. The same anaesthetic medication protocol was used. Systolic and diastolic blood pressure, heart rate, end‐tidal carbondioxide, pulmonary airway pressure and intraocular pressure changes were recorded continuously during pneumoperitoneum and head‐down position. Systolic and diastolic blood pressure decreased after induction of anaesthesia, increased after laryngoscopy and endotracheal intubation. Peak airway pressure increased significantly during pneumoperitoneum and decreased after deflation. Intraocular pressure decreased significantly after induction of anaesthesia and remained unchanged during the pneumoperitoneum and head‐down position. Conclusion In conclusion, adequate depth of anaesthesia may prevent intraocular pressure increase caused pneumoperitoneum and head‐down position. Further studies are required to clarify the picture both in experimental animals and in human.

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Intra‐ocular pressure changes during gynaecological laparoscopy

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Cited by 22 publications

References 11 publications

A comparative study of four combinations of anesthetic drugs for assessing the intraocular pressure changes during gynaecological laparoscopic procedures

A comparative study of four combinations of anesthetic drugs for assessing the intraocular pressure changes during gynaecological laparoscopic procedures

The effect of pneumoperitoneum and head‐down position on intraocular pressure

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