Effects of Total Intravenous Anesthesia on Intraocular Pressure Changes During Robotic Assisted Radical Prostatectomy

Year 2016, Volume: 69 Issue: 3, 247 - 251, 21.12.2016

Gözde İnan

Abstract

Background: Nowadays, the place of robotic surgery in the surgical treatment of prostate cancer is increasing day by day. Despite its advantages, the procedure requires specific positioning; steep Trendelenburg position with non-physiologic effects as increase in the intraocular pressure (IOP). In the present study, it was aimed to investigate the effects of total intravenous anesthesia (TIVA) IOP in patients undergoing robotic assisted radical prostatectomy (RARP).

Materials and methods: Following approval by the institutional ethical comittee, 20 patients (ASA physical status IIII) scheduled for elective prostatectomy in Gazi University Medical Faculty Hospital were enrolled. Standard anesthesia was induced with intravenous propofol (2-3 mg/kg), remifentanil (1 µg/kg), rocuronium (0.6 mg/kg). Following intubation, anesthesia maintainance was provided with propofol (6-10 mg/kg/h) and remifentanil (0.1-0.5 µg/kg/min). The IOP was measured for both eyes at defined intervals during the procedure (T1-6) with Tono-pen XL® tonometer. Duration of surgery, heart rate, mean arterial blood pressure, peak airway pressure and ETCO2 were also recorded.

Results: 10 of 20 patients were ASA I, 9 of them were ASA II and 1 of them was ASA III. Mean age of patients was 60,9 ± 6,9 (41-72) years. Mean duration of surgery was 218,6±69,2 min and Trendelenburg position was 125,8±50,3 min relatively. For both eyes a significant decrease was observed in IOP after anaesthesia induction (T2) compared with baseline measurements (T1) (p< 0.05). Mean IOP < 20 mmHg at all time points.

Conclusion: During RARP, total intravenous anesthesia with propofol and remifentanil can prevent the intraocular pressure increase associated with pneumoperitoneum and steep Trendelenburg position and therefore might be appropriate to reduce postoperative ocular complications in these patients

Keywords

Propofol , Intraocular pressure , Steep Trendelenburg , Laparoscopy

Robotik Radikal Prostatektomilerde Total İntravenöz Anestezinin İntraoküler Basınça Etkileri

Abstract

Amaç: Günümüzde prostat kanserinin cerrahi tedavisinde robotik cerrahinin yeri her geçen gün daha da artmaktadır. Robotik radikal prostatektomi işlemi avantajlarının yanı sıra intraoküler basıncı (İOB) arttırmak gibi olumsuz fizyolojik etkileri olabilecek aşırı Trendelenburg pozisyonu gerektirir. Bu çalışmada, robotik radikal prostatektomi uygulanan hastalarda total intravenöz anestezinin (TİVA) intraoküler basınç üzerine etkilerinin araştırılması amaçlanmıştır.

Yöntem: Çalışmaya, etik kurul onamı alındıktan sonra Gazi Üniversitesi Tıp Fakültesi Hastanesi’nde elektif robotik radikal prostatektomi planlanan 20 (ASA fiziksel skoru I-III) hasta dahil edildi. Standart anestezi indüksiyonu propofol (2- 3 mg/kg), remifentanil (1µg/kg), rokuronyum (0.6 mg/kg) ile gerçekleştirildi. Entübasyonu takiben idame propofol (6- 10 mg/kg/saat), remifentanil (0.1-0.5 µg/kg/dk) ile sağlandı. İntraoküler basınç ölçümleri her iki gözde daha önceden belirlenen 6 zaman diliminde (T1-6) Tono-pen XL el tonometresi ile gerçekleştirildi. Cerrahi süresi, kan basıncı, kalp hızı, tepe havayolu basıncı ve EtCO2 değerleri kaydedildi.

Bulgular: 20 hastadan 10 tanesi ASA I, 9 tanesi ASA II, 1 tanesi ise ASA III idi. Hastaların yaş ortalaması 60,9 ± 6,9 (41- 72) bulundu. Cerrahi süre ortalama 218,6±69,2 dakika, Trendelenburg pozisyonunun süresi ise 125,8±50,3 (75-240) dakika idi. İOB anestezi indüksiyonunu (T2) takiben her iki gözde de başlangıç kontrol (T1) ölçümlerine göre anlamlı olarak düşük bulundu (p<0,05). İOB ortalama değerleri 20 mmHg’nin üzerinde çıkmadı.

Sonuç: Robotik radikal prostatektomide, propofol ile TİVA’nın aşırı Trendelenburg pozisyonunda, CO2 insuflasyonu ile oluşan göz içi basınç artışını önleyebileceği ve dolayısıyla bu hastalarda TİVA uygulamasının postoperatif göz komplikasyonlarını azaltmak için uygun olabileceği düşünüldü

Keywords

Propofol , İntraoküler basınç , Aşırı Trendelenburg , Laparoskopi

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