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Evidence-based Practice and Quality Improvement

Changes in intraocular pressure during steep trendelenburg position under propofol versus sevoflurane anesthesia


Choi, J. H.; Jung, J. W.; Bang, S. R.; Lee, A. R.; Lee, J. J.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 30-30
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Background and Goal of Study: Perioperative visual loss has reported in patients placed trendelenburg position and many previous reports has shown that the intraocular pressure (IOP) was increased in trendelenburg position. Thus, perioperative visual loss may be raised IOP decreasing ocular perfusion and causing an ischemic optic neuropathy. Awad H. et al. have reported that IOP increases significantly in patients undergoing robotic prostatectomy in the steep trendelenburg position.

But there are no reports to compare the IOP changes under propofol and sevoflurane anesthesia. Therefore, we conducted to compare IOP changes under propofol and sevoflurane anesthesia during robotic prostatectomy in the steep trendelenburg position.

Materials and Methods: In prospective randomized controlled study, 27 patients undergoing robotic prostatectomy were studied. Patients were randomly allocated to the propofol or sevoflurane group and the anesthetic agent was administered to maintain the bispectral index between 40 and 60. The IOP was measured using a Tonopen XL hand-held tonometer before anesthesia in supine position (T0), 10 min after intubation (T1), 10 min and 2 hours after steep trandelenburg position & pneumoperitoneum (T2,T3), 10 min after prostatectomy (T4), 10 min after returning to the supine position & deflation of abdominal gas (T5), and 30 min after admitted recovery room (T6).

Results and Discussion: There was a significant increase in IOP during robotic prostatectomy with steep trendelenburg position in both groups. The IOP tended to be higher in the propofol group than in the sevoflurane group, although the differences between the groups were not statistically significant. Patients with glaucoma were not included in our study, further studies would be required to prove the IOP changes in patients with preexisting eye disease.


During robotic prostatectomy with steep trendelenburg position, IOP was significantly increased, but there were no differences between propofol and sevoflurane anesthesia


1. Awad H et al. Anesth Analg. 2009;109(2):473-8. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy.
    2. Weber ED et al. J Neuroophthalmol. 2007;27(4):285-7. Posterior ischemic optic neuropathy after minimally invasive prostatectomy.
      3. Molloy BL. AANA J. 2011;79(2):115-21. Implications for postoperative visual loss: steep trendelenburg position and effects on intraocular pressure.
        © 2013 European Society of Anaesthesiology