title: Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45° Trendelenburg position.
abstract: 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° steep Trendelenburg position (STP).
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  Z-2014-0387-6 . Registered 8 July 2014.
authors.affiliation: Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany. Sebastian.Blecha@ukr.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Blecha
authors.affiliation: Department of Anaesthesiology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
authors.forename: Marion
authors.initials: M
authors.lastname: Harth
authors.affiliation: Department of Neurology, University of Regensburg, and Clinic for Neurological Rehabilitation II, medbo Bezirksklinikum Regensburg, Universitätsstraße 84, 93053, Regensburg, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schlachetzki
authors.affiliation: Centre for Clinical Studies, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Blecha
authors.affiliation: Department of Anaesthesiology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
authors.forename: Pierre
authors.initials: P
authors.lastname: Flora
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Burger
authors.affiliation: Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Denzinger
authors.affiliation: Department of Anaesthesiology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
authors.forename: Bernhard M
authors.initials: BM
authors.lastname: Graf
authors.affiliation: Department of Ophthalmology, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Helbig
authors.affiliation: Department of Anaesthesiology, Caritas St. Josef Medical Center, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Pawlik
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D018475:Head-Down Tilt; D006801:Humans; D001239:Inhalation / Q000502:physiology; D007429:Intraocular Pressure / Q000502:physiology*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009900:Optic Nerve / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D011468:Prostatectomy; D065287:Robotic Surgical Procedures; D014065:Tonometry, Ocular; D014463:Ultrasonography
keywords: Intraocular pressure; Optic nerve sheath diameter; Robotic-assisted laparoscopic prostatectomy; steep Trendelenburg position