Increase in intraocular pressure is less with propofol than with sevoflurane during laparoscopic surgery in the steep Trendelenburg position.
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.
Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Young-Chul
YC
Yoo
Seokyung
S
Shin
Eun Kyeong
EK
Choi
Chan Yun
CY
Kim
Young Deuk
YD
Choi
Sun-Joon
SJ
Bai
D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D018475:Head-Down Tilt; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects*; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage; D011028:Pneumoperitoneum, Artificial / Q000379:methods; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D011468:Prostatectomy / Q000379:methods*; D000077208:Remifentanil; D012371:Robotics; D000077149:Sevoflurane; D013997:Time Factors
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol