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Evidence-based Practice and Quality Improvement

Intraocular pressure changes during laparoscopic nephrectomy

1AP5-5

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

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 19-19
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Background and Goal of Study: Recently, perioperative visual impairments after laparoscopic nephrectomy have been reported. Laparoscopic surgery and intraoperative body position are known to change the intraocular pressure (IOP), but there was no report about the IOP changes during lateral decubitus position combined with pneumoperitoneum. Therefore, we evaluated the combined effects on the IOP between two eyes in patients undergoing laparoscopic nephrectomy.

Materials and Methods: Prospective observational study was conducted with 23 patients with no preexisting eye disease, ASA 1-2, undergoing laparoscopic left nephrectomy. Anesthesia was induced with thiopental sodium and rocuronium and maintained with sevoflurane and 50% oxygen. IOP in both eyes was measured prior to anesthesia in supine position (T0), after intubation (T1), 10 min after lateral decubitus position (T2), 5 min and 30 min after pneumoperitoneum (T3,T4), 5 min and 30 min after mannitol administration (T5,T6), 30 min after the end of pneumopeitoneum (T7), and 30 min after the end of surgery (T8).

Results and Discussion: Baseline (T0) IOP was similar (15.6±3.3 mmHg in non-dependent eye and 15.5±3.7 mmHg in dependent eye) and after intubation, both IOP was significantly decreased from the T0. After pneumoperioneum, both IOP was increased significantly from the T0 (p< 0.0001). The mean IOP in the dependent eye was significantly higher than that in the nondependent eye during the operation with lateral decubitus position and pneumoperitoneum (p=0.0414).

Conclusion(s): Pneumoperitonuem with lateral decubitus position was significantly increased IOP and IOP of dependent eye was more higher increased than nondependent eye.

References:

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      3. Usoltsev NA, Shankar H, Zainer CM.Br J Anaesth. 2011 Oct;107(4):648-9. A case for routine tonometry to avoid postoperative visual loss.
        © 2013 European Society of Anaesthesiology