Intraocular pressure (IOP) more reduced when using TIVA with propofol during robot-assisted laparoscopic radical prostatectomy

Abstract

Intraocular pressure (IOP) is significantly increased during robot-assisted laparoscopic radical prostatectomy (RLRP) which is performed in a steep Trendelenburg position at prolonged times of pneumoperitoneum (PP). Patients undergoing RLRP are often old aged with various comorbities and tend to be vulnerable to postoperative vision loss. Commonly used anesthetics are known to decrease IOP. This prospective randomized study was done to compare the effect of propofol-based total intravenous anesthesia (TIVA) and sevoflurane-based balanced anesthesia on the IOP of elderly patients undergoing RLRP. 66 male patients were randomly assigned to either the control group or the TIVA group with propofol. IOPs were measured at nine different time points. IOP was significantly increased in the control group at T3 (30 min after steep Trendelenburg position), T4 (5 min after returning to horizontal position), and T6 (5 min after tracheal extubation) when compared to the TIVA group with propofol. IOP was significantly lower in the TIVA group compared to the control group at T2 (5 min after PP), T3, and T6. We could confirm that TIVA with propofol was more effective in preventing the increase in IOP caused by PP and steep Trendelenburg position compared to the control group with sevoflurane. TIVA with propofol may beneficial in patients who are at increased risk of ocular complications due to increased IOP during and after RLRP.