Robotik Radikal Prostatektomilerde Total İntravenöz Anestezinin İntraoküler Basınça Etkileri
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
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