Effects of Inhalation Anaesthesia and Total Intravenous Anaesthesia on Intraocular Pressure in Robotic Prostate Surgery

Abstract

Objective: This study aimed to compare the effects of inhalation anesthesia and total intravenous anesthesia on intraocular pressure, as well as to evaluate associated hemodynamic changes, surgical duration, blood gas parameters, and the effects of pneumoperitoneum and steep trendelenburg positioning at different time intervals in patients undergoing robotic prostatectomy. Robot-assisted laparoscopic prostatectomy (RALP) is widely used in the surgical treatment of prostate cancer. Due to patient characteristics, operative duration, and the requirement for a steep Trendelenburg position, RALP is associated with specific physiological changes. One of the most important concerns is the increase in intraocular pressure (IOP), which may lead to ocular complications. This study aimed to compare the effects of inhalation anesthesia and total intravenous anesthesia (TIVA) on intraoperative IOP changes during robotic prostate surgery. Methods: This prospective randomized study included 60 patients scheduled for elective robotic prostatectomy following ethics committee approval. Patients were randomly allocated into two groups: Group 1 received sevoflurane–remifentanil anesthesia, and Group 2 received propofol–remifentanil anesthesia. Intraocular pressure, hemodynamic variables, blood gas parameters, respiratory mechanics, heart rate (HR), systolic, diastolic and mean blood pressures (SBP, DBP, MBP), bispectral index (BIS), peripheral oxygen saturation (SpO₂), and end-tidal carbon dioxide (ETCO₂) were recorded at predefined time points from anesthesia induction to the postoperative period. Results: Demographic characteristics, comorbidities, anesthesia duration, Trendelenburg duration, pneumoperitoneum duration, and surgical time were comparable between the groups (P>.05). No statistically significant difference was observed between the groups with respect to right or left intraocular pressure (IOP) measurements throughout the study period (P>.05). End tidal carbon dioxide (ETCO₂) levels and mean airway pressure were significantly higher in the sevoflurane group (P<.05). In both eyes, IOP showed a positive correlation with heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean blood pressure (MBP) at T1, as well as with ETCO₂ at T8 (P<.05). No significant correlation was found between IOP and peripheral oxygen saturation (SpO₂) or arterial oxygen tension (PaO₂) (P>.05). Conclusion: Although many perioperative factors affect intraocular pressure during robotic prostatectomy, no significant difference was observed between total intravenous anesthesia and inhalation anesthesia in terms of intraocular pressure changes.

Keywords

• Robot-assisted laparoscopic prostatectomy
• intraocular pressure
• anesthetic technique
• inhalation anesthesia
• total intravenous anesthesia

Robotik Prostat Cerrahisinde İnhalasyon Anestezisi ve Total İntravenöz Anestezinin Göz İçi Basıncı Üzerindeki Etkileri

Öz

Amaç: Bu çalışmanın amacı, robot yardımlı laparoskopik prostatektomi uygulanan hastalarda inhalasyon anestezisi ile total intravenöz anestezinin intraoküler basınç üzerindeki etkilerini karşılaştırmak; ayrıca buna eşlik eden hemodinamik değişiklikler, cerrahi süre, kan gazı parametreleri ile pnömoperitoneum ve dik trendelenburg pozisyonunun farklı zaman aralıklarındaki etkilerini değerlendirmektir. Yöntemler: Bu prospektif ve randomize çalışmaya, etik kurul onayı alındıktan sonra elektif robot yardımlı prostatektomi planlanan toplam 60 hasta dahil edildi. Hastalar rastgele iki gruba ayrıldı. Grup 1’e sevofluran–remifentanil ile inhalasyon anestezisi, Grup 2’ye ise propofol–remifentanil ile total intravenöz anestezi uygulandı. İntraoküler basınç, hemodinamik değişkenler, kan gazı parametreleri, solunum mekanikleri, kalp hızı, sistolik, diyastolik ve ortalama kan basınçları, bispektral indeks, periferik oksijen satürasyonu ve end-tidal karbondioksit düzeyleri; anestezi indüksiyonundan postoperatif döneme kadar önceden belirlenmiş zaman noktalarında kaydedildi. Bulgular: Gruplar arasında demografik özellikler, komorbiditeler, anestezi süresi, Trendelenburg süresi, pnömoperitoneum süresi ve cerrahi süre açısından istatistiksel olarak anlamlı fark saptanmadı. Çalışma süresi boyunca sağ ve sol göz intraoküler basınç ölçümleri açısından gruplar arasında anlamlı bir fark gözlenmedi. End-tidal karbondioksit düzeyleri ve ortalama havayolu basıncı sevofluran grubunda anlamlı olarak daha yüksek bulundu. Her iki gözde intraoküler basınç; erken dönemde kalp hızı, sistolik, diyastolik ve ortalama kan basınçlarıyla, geç dönemde ise end-tidal karbondioksit düzeyleriyle pozitif korelasyon olduğu gösterildi. İntraoküler basınç ile periferik oksijen satürasyonu veya arteriyel oksijen basıncı arasında anlamlı bir ilişki saptanmadı. Sonuç: Robot yardımlı prostatektomi sırasında intraoküler basınç üzerinde birçok perioperatif faktör etkili olmakla birlikte, total intravenöz anestezi ile inhalasyon anestezisi arasında intraoküler basınç değişiklikleri açısından anlamlı bir fark bulunmamıştır.

Anahtar Kelimeler

• Robot yardımlı laparoskopik prostatektomi
• intraoküler basınç
• inhalasyon anestezisi
• total intravenöz anestezi.

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