Blecha, Sebastian and Harth, Marion and Schlachetzki, Felix and Zeman, Florian and Blecha, Christiane and Flora, Pierre and Burger, Maximilian and Denzinger, Stefan and Graf, Bernhard M. and Helbig, Horst and Pawlik, Michael T. (2017) Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45 degrees Trendelenburg position. BMC ANESTHESIOLOGY, 17: 40. ISSN 1471-2253,
Full text not available from this repository. (Request a copy)Abstract
Background: To evaluate changes in intraocular pressure (IOP) and intracerebral pressure (ICP) reflected by the optic nerve sheath diameter (ONSD) in patients undergoing robotic-assisted laparoscopic prostatectomy (RALP) in permanent 45 degrees steep Trendelenburg position (STP). Methods: Fifty-one patients undergoing RALP under a standardised anaesthesia. IOP was perioperatively measured in awake patients (T0) and IOP and ONSD 20 min after induction of anaesthesia (T1), after insufflation of the abdomen in supine position (T2), after 30 min in STP (T3), when controlling Santorini's plexus in STP (T4) and before awakening while supine (T5). We investigated the influence of respiratory and circulatory parameters as well as patient-specific and time-dependent factors on IOP and ONSD. Results: Average IOP values (mmHg) were T0 = 19.9, T1 = 15.9, T2 = 20.1, T3 = 30.7, T4 = 33.9 and T5 = 21.8. IOP was 14. 0 +/- 7.47 mmHg (mean +/- SD) higher at T4 than T0 (p = 0.013). Univariate mixed effects models showed peak inspiratory pressure (PIP) and mean arterial blood pressure (MAP) to be significant predictors for IOP increase. Mean ONSD values (mm) were T1 = 5.88, T2 = 6.08, T3 = 6.07, T4 = 6.04 and T5 = 5.96. The ONSD remained permanently > 6.0 mm during RALP. Patients aged < 63 years showed a 0.21 mm wider ONSD on average (p = 0.017) and greater variations in diameter than older patients. Conclusions: The combination of STP and capnoperitoneum during RALP has a pronounced influence on IOP and, to a lesser degree, on ICP. IOP is directly correlated with increasing PIP and MAP. IOP doubled and the ONSD rose to values indicating increased intracranial pressure. Differences in the ONSD were age-related, showing higher output values as well as better autoregulation and compliance in STP for patients aged < 63 years. Despite several ocular changes during RALP, visual function was not significantly impaired postoperatively.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | RADICAL PROSTATECTOMY; INTRACRANIAL-PRESSURE; SONOGRAPHY; ULTRASONOGRAPHY; POPULATION; ULTRASOUND; ANESTHESIA; MANAGEMENT; PROPOFOL; Intraocular pressure; Optic nerve sheath diameter; Robotic-assisted laparoscopic prostatectomy; steep Trendelenburg position |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 14 Dec 2018 13:00 |
| Last Modified: | 20 Feb 2019 11:38 |
| URI: | https://pred.uni-regensburg.de/id/eprint/222 |
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