780 INTRAOCULAR PRESSURE INCREASE DURING ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: BALANCED ANESTHESIA VERSUS TOTAL INTRAVENUS ANESTHESIA

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011780 INTRAOCULAR PRESSURE INCREASE DURING ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: BALANCED ANESTHESIA VERSUS TOTAL INTRAVENUS ANESTHESIA Eliana Calza, Francesco Porpiglia, Cristian Fiori, Andrea Giannone, Andrea Pusineri, Alessandro Meli, Francesca Prieri, Christian Luigi Demasi, Catena Francesca, and Augusto Tempia Eliana CalzaEliana Calza Orbassano - Torino, Italy More articles by this author , Francesco PorpigliaFrancesco Porpiglia Orbassano - Torino, Italy More articles by this author , Cristian FioriCristian Fiori Orbassano - Torino, Italy More articles by this author , Andrea GiannoneAndrea Giannone Orbassano - Torino, Italy More articles by this author , Andrea PusineriAndrea Pusineri Orbassano - Torino, Italy More articles by this author , Alessandro MeliAlessandro Meli Orbassano - Torino, Italy More articles by this author , Francesca PrieriFrancesca Prieri Orbassano - Torino, Italy More articles by this author , Christian Luigi DemasiChristian Luigi Demasi Orbassano - Torino, Italy More articles by this author , Catena FrancescaCatena Francesca Orbassano - Torino, Italy More articles by this author , and Augusto TempiaAugusto Tempia Orbassano - Torino, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1819AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Permanent visual loss during non-ophthalmic surgery is a rare but devastating cause of post-operative morbidity. One common diagnosis is ischemic optic neuropathy due to the excessive increase of intraocular pressure (IOP) during procedure. Robot-assisted laparoscopic prostatectomy (RALP) needs patients are positioned on operating table tilted about 30–35 degrees and the pneumoperitoneum pressure is about 13 mmHg; those factors lead to IOP increase. In addition volatile or intravenous anesthetics contribute to increase IOP. Anesthesiologist has to provide adequate control of IOP. METHODS We performed a prospective, randomized study to compare the effects of volatile versus intravenous anesthetics on IOP increasing during RALP. IOP was measured using OBF Langham System tonometer in ASA I and II patients undergoing elective RALP. 40 patients were randomized in 2 groups: group B received balanced anesthesia with volatile anesthetics, group T received total intravenous anesthesia with propofol and remifentanil. Exclusion criteria were adverse reactions to any of the anesthetic agents used in the study and ophthalmic disease. The IOP was measured before anesthesia while supine and awake (baseline or T0), anesthetized and supine after induction (T1), anesthetized after insufflation of the abdomen with carbon dioxide (CO2) in steep Trendelenburg at the beginning (T2) and at the end of the surgery (T3), finally anesthetized supine before awakening (T4). The primary end point of our study was to investigate any differences in IOP of patients underwent balanced versus total intravenous anesthesia. RESULTS T0 was 18,8±1,7 mmHg in Group T and 18,7±1,6 mmHg in Group B. IOP decreased to a minimum of 12,2±3,1 mmHg after induction (T1) in Group T and to 13,2±4 mmHg in Group B. At time point T2 IOP was 25,4±3,8 in Group T, significally lower than in Group B, 30,2±6,2 (p 0,015). IOP at T3 was lower in Group T, 29.9±3 than is Group B, 34,2±4,3 (p 0,004). At T4 IOP decreases to 21,8±3,5 in Group T and 22,8±4,9 in Group B. CONCLUSIONS During RALP IOP reaches levels that are comparable with those observed in glaucoma patients in both of the groups. Our results demonstrate that the increase of IOP was more pronounced and sustained in the balanced anaesthesia as compared with total intravenous anesthesia. IOP increase may not be of any consequence in the majority of patients undergoing RALP, but it may be harmful in patients with glaucoma. We conclude that total intravenous anesthesia is the safer anesthetic regimen during RALP, especially in patients at risk. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e314 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eliana Calza Orbassano - Torino, Italy More articles by this author Francesco Porpiglia Orbassano - Torino, Italy More articles by this author Cristian Fiori Orbassano - Torino, Italy More articles by this author Andrea Giannone Orbassano - Torino, Italy More articles by this author Andrea Pusineri Orbassano - Torino, Italy More articles by this author Alessandro Meli Orbassano - Torino, Italy More articles by this author Francesca Prieri Orbassano - Torino, Italy More articles by this author Christian Luigi Demasi Orbassano - Torino, Italy More articles by this author Catena Francesca Orbassano - Torino, Italy More articles by this author Augusto Tempia Orbassano - Torino, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...