Goel Nitesh, Chowdhury Itee, Dubey Jitendra, Mittal Amit, Pathak Soumi
Department of Anaesthesia, Rajiv Gandhi Cancer Institute and Research Centre, Sec-5, Rohini, New Delhi, India.
J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):546-551. doi: 10.4103/joacp.JOACP_96_20. Epub 2021 Jan 18.
Raised intraocular pressure (IOP) is one of the known causes of anterior ischemic optic neuropathy. In the case of robotic urological-gynecological surgeries, patient is kept in steep Trendelenburg supine-lithotomy position. Aim of this study was to observe the quantitative rise in IOP in steep Trendelenburg position (>45°) in robotic-assisted prostatectomy and hysterectomy.
After institutional ethical clearance and written informed consent, 100 patients undergoing robotic surgeries in steep Trendelenburg position were recruited for the study. IOP was measured at different time intervals in steep Trendelenburg position using Schiotz tonometer: Post intubation (T1), post pneumoperitoneum (T2), post steep Trendelenburg (T3), and rest readings were taken 30 min apart. T9 was taken 10 min after patient is made supine and parallel to the ground. Mean arterial pressure (MAP), positive inspiratory pressure (PIP), and end-tidal carbon dioxide (EtCO2) values were recorded at different time points. Descriptive analysis, linear regression analysis, and Freidman's nonparametric tests were used to analyze the results.
Ninety-five patients were included for statistical analysis as five patients were excluded due to intraoperative interventions leading to alteration of results. Mean IOP at T1 was 19.181/18.462 mmHg in L/R eye. A gradual rise in IOP was observed with every time point while patient was in steep Trendelenburg position which reverts back to near normal values once the patient is changed to normal position 21.419/20.671: Left/right eye in mm of Hg. Uni and multiple regression analysis showed insignificant value, thus no correlation between MAP, PIP, and EtCO2 with IOP.
Steep Trendelenburg position for prolong duration leads to significant rise in intraocular pressure.
眼压升高是前部缺血性视神经病变的已知病因之一。在机器人辅助泌尿外科 - 妇科手术中，患者需保持极度头低脚高位仰卧截石位。本研究的目的是观察在机器人辅助前列腺切除术和子宫切除术中，患者处于极度头低脚高位（>45°）时眼压的定量升高情况。
经机构伦理审查并获得书面知情同意后，招募了100例接受机器人手术且处于极度头低脚高位的患者参与本研究。使用Schiotz眼压计在不同时间间隔测量处于极度头低脚高位时的眼压：插管后（T1）、气腹后（T2）、极度头低脚高位后（T3），其余读数每隔30分钟测量一次。T9在患者恢复仰卧位并与地面平行10分钟后测量。在不同时间点记录平均动脉压（MAP）、吸气峰压（PIP）和呼气末二氧化碳（EtCO2）值。采用描述性分析、线性回归分析和Friedman非参数检验对结果进行分析。
95例患者纳入统计分析，5例患者因术中干预导致结果改变而被排除。T1时左眼/右眼平均眼压为19.181/18.462 mmHg。在患者处于极度头低脚高位时，随着每个时间点观察到眼压逐渐升高，一旦患者恢复正常体位，眼压又恢复到接近正常水平，左眼/右眼为21.419/20.671 mmHg（毫米汞柱）。单因素和多因素回归分析显示无显著相关性，因此MAP、PIP和EtCO2与眼压之间无相关性。
长时间处于极度头低脚高位会导致眼压显著升高。
