Intraocular Pressure Changes With Positioning During Laparoscopy

Abstract

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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“…3 Additionally, there is an increase in IOP and vitreous pressure from increased venous pressure. 4 , 5 This may be compensated for by raising the height of the infusion bottle. 6 Similarly, every patient presenting with spinal deformities will have curvature of the spine to varying degrees.…”

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“…Perioperative visual disturbance or loss has been reported as an uncommon side effect after such a procedure. 42 , 43 , 44 , 45 , 46 This presumably results from the transmission of IAP along the spine into the skull base EDNAC segments and then through into the orbit, causing increased intraocular pressure (IOP). Adisa et al 45 reported that the resultant intraocular venous congestion in the orbital EDNAC segment can manifest as perioperative visual impairment via ischemic optic neuropathy or retinal vascular occlusion.…”

“…This phenomenon of an elevated IOP can be further exacerbated by patient positioning during operations, particularly in the steep Trendelenburg and prone jackknife positions where the effects of gravity, in tandem with an increased IAP, can further elevate ICP and IOP. 44,45,[47][48][49] Such a prolonged head-down orientation during surgical procedures should best be avoided for fragile patients (e.g., those with a diagnosis of coronavirus disease 2019). A number of recent reports have emphasized the use of the prone position for surgery in this patient group as this position will minimally alter IAP and IOP.…”

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“…The results describe a significant IOP increase in the Trendelenburg position after pneumoperitoneum introduction, which returned to baseline values in the supine position after pneumoperitoneum evacuation. In their study on adult humans, Adisa et al (2016) observed a mild increase in IOP after pneumoperitoneum induction, with a mean difference of +2.85 mmHg in the reverse Trendelenburg and +0.40 mmHg in the Trendelenburg group. Also, Grosso et al (2013) found that standard pneumoperitoneum pressures (≤ 14 mmHg) led to mild and reversible IOP increases.…”