Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors

Shirono, Yuko; Takizawa, Itsuhiro; Kasahara, Takashi; Maruyama, Ryo; Yamana, K.; Tanikawa, Toshiki; Hara, Noboru; Sakaue, Yuta; Togano, Tetsuya; Nishiyama, Tsutomu; Fukuchi, Takeo; Tomita, Yoshihiko

doi:10.1186/s12894-020-00595-5

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…These effects result in a decrease in cerebral and ocular perfusion pressure, increasing the risk of postoperative cognitive dysfunction and ocular complications. It has been reported that the IOP value decreased after the induction of anesthesia and increased after the induction of pneumoperitoneum in steep Trendelenburg position ranging between 5 and 8 mmHg [39,40]. The longer was the console time, higher the increase in IOP [38 && ].…”

Section: Intraocular Pressurementioning

confidence: 99%

The intraoperative management of robotic-assisted laparoscopic prostatectomy

Chiumello,

Fratti,

Coppola

2023

Current Opinion in Anaesthesiology

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Purpose of review Robotic-assisted laparoscopic radical prostatectomy has become the second most commonly performed robotic surgical procedure worldwide, therefore, anesthesiologists should be aware of the intraoperative pathophysiological consequences. The aim of this narrative review is to report the most recent updates regarding the intraoperative management of anesthesia, ventilation, hemodynamics and central nervous system, during robotic-assisted laparoscopic radical prostatectomy. Recent findings Surgical innovations and the advent of new technologies make it imperative to optimize the anesthesia management to provide the most holistic approach possible. In addition, an ageing population with an increasing burden of comorbidities requires multifocal attention to reduce the surgical stress. Summary Total intravenous anesthesia (TIVA) and balanced general anesthesia are similar in terms of postoperative complications and hospital stay. Reversal of rocuronium is associated with shorter hospital stay and postanesthesia recovery time. Adequate PEEP levels improve oxygenation and driving pressure, and the use of a single recruitment maneuver after the intubation reduces postoperative pulmonary complications. Restrictive intravenous fluid administration minimizes bladder–urethra anastomosis complications and facial edema. TIVA maintains a better autoregulation compared with balanced general anesthesia. Anesthesiologists should be able to optimize the intraoperative management to improve outcomes.

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Section: Intraocular Pressurementioning

confidence: 99%

The intraoperative management of robotic-assisted laparoscopic prostatectomy

Chiumello,

Fratti,

Coppola

2023

Current Opinion in Anaesthesiology

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“…Most studies are small and limited, measuring intraocular pressure mostly in nonglaucomatous subjects. [173][174][175][176][177][178][179][180] Head-down Positioning in Subjects with Glaucoma: Nonsurgical. Moderate head-down tilting can be used as a provocative test to identify patients who progress to development of glaucoma.…”

Section: Preoperative Evaluation and Anesthetic Carementioning

confidence: 99%

“…Most studies are small and limited, measuring intraocular pressure mostly in nonglaucomatous subjects. 173–180…”

Section: Optic Nervementioning

confidence: 99%

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

et al. 2022

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The authors reviewed perioperative ocular complications and implications of ocular diseases during nonocular surgeries. Exposure keratopathy, the most common perioperative eye injury, is preventable. Ischemic optic neuropathy, the leading cause of perioperative blindness, has well-defined risk factors. The incidence of ischemic optic neuropathy after spine fusion, but not cardiac surgery, has been decreasing. Central retinal artery occlusion during spine fusion surgery can be prevented by protecting eyes from compression. Perioperative acute angle closure glaucoma is a vision-threatening emergency that can be successfully treated by rapid reduction of elevated intraocular pressure. Differential diagnoses of visual dysfunction in the perioperative period and treatments are detailed. Although glaucoma is increasingly prevalent and often questions arise concerning perioperative anesthetic management, evidence-based recommendations to guide safe anesthesia care in patients with glaucoma are currently lacking. Patients with low vision present challenges to the anesthesia provider that are becoming more common as the population ages.

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“…In 2017 Ozcan et al [ 30 ] analysed the effect of STP on IOP during robotic surgery including 43 RALP cases, finding that the highest IOP was at the end of ST under pneumoperitoneum, whereas in 2020 Shirono et al [ 31 ] discovered that IOP increased 1 h after induction of pneumoperitoneum in STP, remaining elevated in a time-dependent manner during STP.…”

Section: Timingmentioning

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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Intraoperative intraocular pressure changes during robot-assisted radical prostatectomy: associations with perioperative and clinicopathological factors

Cited by 8 publications

References 14 publications

The intraoperative management of robotic-assisted laparoscopic prostatectomy

The intraoperative management of robotic-assisted laparoscopic prostatectomy

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

The Impact of Steep Trendelenburg Position on Intraocular Pressure

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