Intraocular pressure changes during laparoscopic surgery in Trendelenburg position in patients anesthetized with propofol-based total intravenous anesthesia compared to sevoflurane anesthesia: A comparative study

Abstract

Background:Intraocular pressure (IOP) is increased during laparoscopic surgery with Trendelenburg position and may contribute to deleterious effects on optic nerve in susceptible patients.Aims:The primary objective of this study is to compare the effects of propofol-based total intravenous anesthesia (TIVA) with those of sevoflurane anesthesia on IOP in patients undergoing lower abdominal laparoscopic surgery in Trendelenburg position. Secondary objectives are to compare hemodynamic changes, mean arterial pressure (MAP), end-tidal CO2, and peak inspiratory pressure changes.Materials and Methods:Sixty patients with physical status American Society of Anesthesiologists classes I and II were randomly allocated in two groups: Group A (propofol) and Group B (sevoflurane). IOP along with other parameters was measured at seven points including baseline (T0), 5 min after induction (T1), 5 min after CO2 pneumoperitoneum in supine position (T2), 30 min after CO2 pneumoperitoneum with Trendelenburg position (T3), 5 min after returning to supine position (T4), 5 min after CO2 desufflation (T5), and 5 min after extubation (T6).Results:The change in IOP was different between the two groups. Maximum rise in IOP was seen at T3, and mean ± standard deviation IOP was 15.5 ± 0.9 mmHg and 19.8 ± 1.2 mmHg in Group A and Group B, respectively (P < 0.01). In Group A (propofol), IOP remained almost equal to the baseline value at T3 and the IOP difference was 0.3 ± 0.9 mmHg less than baseline (statistically insignificant, P > 0.05), while in Group B (sevoflurane), IOP increased significantly at T3 and the difference was 4.0 ± 1.2 mmHg (P < 0.001). The IOP was significantly greater (P < 0.01) from T2 to T6 in sevoflurane group than propofol group.Conclusion:Propofol-based TIVA is more effective than inhalational anesthesia with sevoflurane in attenuating the increase in IOP during laparoscopic surgery requiring CO2 pneumoperitoneum with Trendelenburg position.

Optic nerve sheath diameter changes during gynecologic surgery in the Trendelenburg position: comparison of propofol-based total intravenous anesthesia and sevoflurane anesthesia

“…Previous studies compared propofol-based total intravenous anesthesia (TIVA) to sevoflurane anesthesia using IOP measurement. Kaur et al [ 10 ] demonstrated that propofol-based TIVA was superior to sevoflurane anesthesia by direct intraoperative measurement of IOP during laparoscopic surgery in the Trendelenburg position. Yoo et al [ 11 ] also observed that propofol-based TIVA is superior to sevoflurane anesthesia in attenuating the increase of IOP during laparoscopic surgery in the Trendelenburg position.…”

Clinical Anatomy of the Extradural Neural Axis Compartment: A Literature Review

“… 50 , 51 , 52 , 53 Nonetheless, some anesthetic medications, in particular, propofol, have been reported to mitigate an increased IOP and its sequelae during surgery even in the presence of an increased IAP and steep patient positioning. 54 , 55 , 56 , 57 , 58 …”

“…[50][51][52][53] Nonetheless, some anesthetic medications, in particular, propofol, have been reported to mitigate an increased IOP and its sequelae during surgery even in the presence of an increased IAP and steep patient positioning. [54][55][56][57][58] Controversy It has been claimed that all of the cranial sinuses lie in the "interperiosteodural space." 14,15 Although some general features characterize the periosteal and meningeal dural layers, the border between them is not distinct.…”

Prospective evaluation of visual function in patients with ocular diseases after robot‐assisted laparoscopic prostatectomy

“…Furthermore, our anesthesia technique was not standardized during this study. Recent studies reported that TIVA was more effective than inhalational anesthesia with sevoflurane in controlling IOP changes during TP . Therefore, anesthesia technique should ideally be standardized in all patients, although this is not realistic in a larger cohort study involving multiple anesthesiologists.…”

“…Recent studies reported that TIVA was more effective than inhalational anesthesia with sevoflurane in controlling IOP changes during TP. 23,24 Therefore, anesthesia technique should ideally be standardized in all patients, although this is not realistic in a larger cohort study involving multiple anesthesiologists. Regarding the ophthalmic examination, the visual field test is based on a subjective examination and the corresponding fluctuation should be considered as an important context, because most patients were not accustomed to the visual field test.…”