Background: Pneumoperitoneum in the pelvic laparoscopic surgery induces a rise in the intraocular pressure (IOP). This study investigated whether IOP changes were different depending on the surgical position (Trendelenburg vs. reverse Trendelenburg) and the anesthetic drugs (propofol vs. desflurane).
Methods: : A total of 100 patients scheduled for pelvic laparoscopy or laparoscopic cholecystectomy were enrolled. They were randomly allocated into the propofol group or the desflurane group. In the desflurane group, anesthesia was given with thiopental and desflurane. The propofol group was anesthetized with propofol. IOP, mean blood pressure, heart rate, and peak airway pressure were measured at the following time points: awake-supine position, induction of anesthesia, after position change, 5, 10, and 20 minutes after pneumoperitoneum. IOP was measured with the handheld tonometer (Tono-penXL).
Results: : In all the groups, IOP decreased after anesthesia was initiated (17 ± 2 to 11 ± 2 mm Hg). In laparoscopic cholecystectomy, a low IOP was maintained during the period of pneumoperitoneum, independent of anesthetic drugs. In pelvic laparoscopy, the head-down position produced a rise in IOP (11 ± 2 to 14 ± 3 mm Hg). Further, pneumoperitoneum in addition to the head-down position raised the IOP highly in the desflurane group, and the average IOP value was over the normal limit (22 ± 4 mm Hg). In contrast, propofol kept IOP similar to the preoperative level during the whole period of pneumoperitoneum (18 ± 3 mm Hg, P<0.001 vs. desflurane).
Conclusions: : Impact of anesthetics on IOP during laparoscopic surgery may change depending on the surgical position. For the laparoscopic surgery performed in the head-down position, propofol may be more helpful in preventing ocular hypertension.