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Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep Trendelenburg position

 Young-Chul Yoo  ;  Seokyung Shin  ;  Eun Kyeong Choi  ;  Chan Yun Kim  ;  Young Deuk Choi  ;  Sun-Joon Bai 
 Canadian Journal of Anesthesia, Vol.61(4) : 322-329, 2014 
Journal Title
 Canadian Journal of Anesthesia 
Issue Date
Aged ; Anesthetics, Inhalation/administration & dosage ; Anesthetics, Inhalation/adverse effects ; Anesthetics, Intravenous/administration & dosage ; Anesthetics, Intravenous/adverse effects ; Head-Down Tilt ; Humans ; Intraocular Pressure/drug effects* ; Laparoscopy/methods ; Male ; Methyl Ethers/administration & dosage ; Methyl Ethers/adverse effects* ; Middle Aged ; Piperidines/administration & dosage ; Pneumoperitoneum, Artificial/methods ; Propofol/administration & dosage ; Propofol/adverse effects* ; Prostatectomy/methods* ; Robotics ; Time Factors
Mean Arterial Pressure ; Sevoflurane ; Central Venous Pressure ; Remifentanil ; Desflurane
BACKGROUND: Intraocular pressure is increased during laparoscopic surgeries performed in a steep Trendelenburg position. This study compared the effects of propofol with those of sevoflurane on intraocular pressure in patients undergoing robot-assisted laparoscopic radical prostatectomy in a 30° Trendelenburg position. METHODS: Sixty-six patients were randomly allocated to a maintenance anesthetic consisting of remifentanil and sevoflurane (Sevoflurane Group) or remifentanil and propofol (Propofol Group). Intraocular pressure (IOP) was measured at nine predefined time points, including baseline (T0), five minutes after establishing pneumoperitoneum (T2), 30 min after establishing the Trendelenburg position with pneumoperitoneum (T3), five minutes after returning to the horizontal position (T4), and immediately after tracheal extubation (T6). The primary outcome was the change in intraocular pressure from T0 to T3. RESULTS: The results of linear mixed model analysis showed that intraocular pressure differed between the two groups (P = 0.0039). At T3, the mean (SD) IOP was greater in the Sevoflurane Group [23.5 (4.3) mmHg] than in the Propofol Group [19.9 (3.8) mmHg] (P = 0.0019). At T2 and T6, IOP was also greater in the Sevoflurane Group than in the Propofol Group (P = 0.038 and P = 0.009, respectively). There was a statistically significant increase in intraocular pressure from baseline to T3 (pneumoperitoneum and steep Trendelenberg) in the Sevoflurane Group [6.0 (5.0) mmHg; P < 0.001] but not in the Propofol Group [2.1 (5.1) mmHg; P = 0.136]. None of the patients experienced ocular complications. CONCLUSIONS: Intraocular pressure increases after pneumoperitoneum and the steep Trendelenburg position are established. This increase is less with propofol than with sevoflurane anesthesia. This trial was registered at ClinicalTrials.gov: NCT01744262.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Ophthalmology (안과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Chan Yun(김찬윤) ORCID logo https://orcid.org/0000-0002-8373-9999
Bai, Sun Joon(배선준) ORCID logo https://orcid.org/0000-0001-5027-3232
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Yoo, Young Chul(유영철) ORCID logo https://orcid.org/0000-0002-6334-7541
Choi, Young Deuk(최영득) ORCID logo https://orcid.org/0000-0002-8545-5797
Choi, Eun Kyeong(최은경)
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