Abstract
Purpose: To evaluate the effects of laparoscopic cholecystectomy in patients with gall stones under general anesthesia using carbon dioxide (CO2) insufflations on the intraocular pressure (IOP). Methods: The study was an observational case series, involved 24 non-glaucomatous patients with gall stones who underwent laparoscopic cholecystectomy surgery under general anesthesia using (CO2) insufflations in the period from January 2016 to April 2016 in Zagazig University Hospitals. IOP was measured preoperatively, intra-operatively and shortly postoperatively. Interpretation of the results was performed. Results: The study revealed that IOP was elevated significantly during laparoscopic cholecystectomy surgery (P < 0.001), as the mean preoperative IOP was (15.21 ± 1.61 mmHg) compared to intra-operative (24.55 ± 6.28 mmHg) and nearly returned to the normal level after 8 hours postoperatively (16.13 ± 2.44 mmHg). Conclusion: Laparoscopic cholecystectomy surgery elevated IOP significantly which is not favorable for glaucoma or ocular hypertension patients, especially for the old.
Highlights
During laparoscopic cholecystectomy, to make the gravitational displacement of the viscera away from the site of surgery, patients must put in reverse Trendelenburg position
This observational study included 24 non glaucomatous patients with gall stones who were prepared for laparoscopic cholecystectomy under general anesthesia in Zagazig University Hospitals in the period from January 2016 to April 2016
Cases were subjected to the followings: -Full medical history; -General medical examination for fitness for general anesthesia; -General surgical examination for surgical evaluation of gall bladder; -Abdominal ultrasonography. -Laboratory investigations including: Complete blood count (CBC), liver and kidneys functions tests, bleeding and clotting time and hepatitis B and C Elisa body’s detection
Summary
To make the gravitational displacement of the viscera away from the site of surgery, patients must put in reverse Trendelenburg position. This position results in decreased venous return, right atria pressure, and falls in mean arterial pressure and cardiac output [1] [2]. Central Venous Pressure (CVP) increased due to abdominal carbon dioxide (CO2) insufflations. M. Nada 32 pressure (IOP) is significantly increased during laparoscopic cholecystectomy due to elevated CVP in CO2 filled abdomens in spite of reverse Trendelenburg position [3]. Alterations of the CVP induced by hydrostatic factors in postural changes during laparoscopic cholecystectomy, placing the head 15 degrees above or below the horizontal level, caused IOP changes [4]
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