A Comparative Assessment of Intraocular Pressure in Prolonged Steep Trendelenburg Position Versus Level Supine Position Intervention

Objective: To evaluate the intraocular pressure (IOP) during laparoscopic hysterectomy of patients in the steep trendelenburg (ST) position under propofol anesthesia. Methods: Seventy female patients, without history of ocular pathology, undergoing elective laparoscopic hysterectomy, were randomly assigned to control (Con) group or dexmedetomidine (Dex) group. The Dex group was treated with a loading dose of Dex (1 μg/kg), infusing intravenously over 15 min, followed by continuous infusion of Dex (0.4 μg/kg/h) until the end of procedure. The Con group received an equal volume of normal saline. IOP was measured three times in each eye at 11 different time points. Intraoperative data, mean arterial pressure, heart rate, and end-tidal CO2, total dose of propofol and remifentanil were measured. Results: The IOP was increased in a time dependent manner following anesthesia induction until the end of surgery period under the ST position (T3–T8), while this tendency was depressed by Dex at T7 (p = 0.024) and T8 (p = 0.004) points as compared to the Con group. IOP was declined in the Dex group at 5 and 60 min after tracheal extubation (p = 0.000 and p = 0.007, respectively). Compared with T1 point, the IOP recovered to the baseline in the Dex group at T10 point (p = 0.235), but not in the Con group (p = 0.009). Conclusions: IOP can be controlled to a certain level in patients undergo laparoscopic hysterectomy in the ST position when receiving propofol combined with Dex which can also promote the IOP recovery to the preoperative level during the immediate post-tracheal extubation period.

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Intraoperative changes in whole-blood viscosity in patients undergoing robot-assisted laparoscopic prostatectomy in the steep Trendelenburg position with pneumoperitoneum: a prospective nonrandomized observational cohort study

BMC Anesthesiology ◽

10.1186/s12871-019-0919-z ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Jung-Woo Shim ◽

Hyun Kyung Moon ◽

Yong Hyun Park ◽

Misun Park ◽

Jaesik Park ◽

...

Keyword(s):

Shear Rate ◽

Supine Position ◽

Blood Viscosity ◽

Whole Blood ◽

Hematocrit Level ◽

Robot Assisted ◽

Trendelenburg Position ◽

Whole Blood Viscosity ◽

Laparoscopic Prostatectomy ◽

Steep Trendelenburg Position

Abstract Background The aim of this study was to investigate the effect of the steep Trendelenburg position (STP) with pneumoperitoneum on whole-blood viscosity (WBV) in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). The study also analyzed the associations of clinical patient-specific and time-dependent variables with WBV and recorded postoperative outcomes. Methods Fifty-eight adult male patients (ASA physical status of I or II) undergoing elective RALP were prospectively analyzed in this study. WBV was intraoperatively measured three times: at the beginning of surgery in the supine position without pneumoperitoneum; after 30 min in the STP with pneumoperitoneum; and at the end of surgery in the supine position without pneumoperitoneum. The WBV at a high shear rate (300 s− 1) was recorded as systolic blood viscosity (SBV) and that at a low shear rate (5 s− 1) was recorded as diastolic blood viscosity (DBV). Systolic blood hyperviscosity was defined as > 13.0 cP at 300 s− 1 and diastolic blood hyperviscosity was defined as > 4.1 cP at 5 s− 1. Results The WBV and incidences of systolic and diastolic blood hyperviscosity significantly increased from the supine position without pneumoperitoneum to the STP with pneumoperitoneum. When RALP was performed in the STP with pneumoperitoneum, 12 patients (27.3%) who had normal SBV at the beginning of surgery and 11 patients (26.8%) who had normal DBV at the beginning of surgery developed new systolic and diastolic blood hyperviscosity, respectively. The degree of increase in WBV after positioning with the STP and pneumoperitoneum was higher in the patients with hyperviscosity than in those without hyperviscosity at the beginning of surgery. Higher preoperative body mass index (BMI) and hematocrit level were associated with the development of both systolic and diastolic blood hyperviscosity in the STP with pneumoperitoneum. All patients were postoperatively discharged without fatal complications. Conclusions Changes in surgical position may influence WBV, and higher preoperative BMI and hematocrit level are independent factors associated with the risk of hyperviscosity during RALP in the STP with pneumoperitoneum. Trial registration Clinical Research Information Service, Republic of Korea, approval number: KCT0003295 on October 25, 2018.

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Changes in intraocular pressure during steep trendelenburg position under propofol versus sevoflurane anesthesia

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00093 ◽

2013 ◽

Vol 30 ◽

pp. 30-30

Author(s):

J. H. Choi ◽

J. W. Jung ◽

S. R. Bang ◽

A. R. Lee ◽

J. J. Lee

Keyword(s):

Intraocular Pressure ◽

Sevoflurane Anesthesia ◽

Trendelenburg Position ◽

Steep Trendelenburg Position

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Intraocular Pressure Elevation During Laparoscopic Hysterectomy of Patients in the Steep Trendelenburg Position Under Propofol Anesthesia

Journal of Medical Imaging and Health Informatics ◽

10.1166/jmihi.2019.2620 ◽

2019 ◽

Vol 9 (2) ◽

pp. 297-302

Author(s):

Li-Jun Weng ◽

Xian-Wen Hu ◽

Yun Li ◽

Shi-Yun Jin ◽

Rui Li ◽

...

Keyword(s):

Intraocular Pressure ◽

Laparoscopic Hysterectomy ◽

Tracheal Extubation ◽

Anesthesia Induction ◽

Dependent Manner ◽

Trendelenburg Position ◽

Steep Trendelenburg Position ◽

Intraocular Pressure Elevation ◽

History Of ◽

End Tidal

Objective: To evaluate the intraocular pressure (IOP) during laparoscopic hysterectomy of patients in the steep trendelenburg (ST) position under propofol anesthesia. Methods: Seventy female patients, without history of ocular pathology, undergoing elective laparoscopic hysterectomy, were randomly assigned to control (Con) group or dexmedetomidine (Dex) group. The Dex group was treated with a loading dose of Dex (1 μg/kg), infusing intravenously over 15 min, followed by continuous infusion of Dex (0.4 μg/kg/h) until the end of procedure. The Con group received an equal volume of normal saline. IOP was measured three times in each eye at 11 different time points. Intraoperative data, mean arterial pressure, heart rate, and end-tidal CO2, total dose of propofol and remifentanil were measured. Results: The IOP was increased in a time dependent manner following anesthesia induction until the end of surgery period under the ST position (T3–T8), while this tendency was depressed by Dex at T7 (p = 0.024) and T8 (p = 0.004) points as compared to the Con group. IOP was declined in the Dex group at 5 and 60 min after tracheal extubation (p = 0.000 and p = 0.007, respectively). Compared with T1 point, the IOP recovered to the baseline in the Dex group at T10 point (p = 0.235), but not in the Con group (p = 0.009). Conclusions: IOP can be controlled to a certain level in patients undergo laparoscopic hysterectomy in the ST position when receiving propofol combined with Dex which can also promote the IOP recovery to the preoperative level during the immediate post-tracheal extubation period.

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