Propofol Affects Optic Nerve Sheath Diameter less than Sevoflurane during Robotic Surgery in the Steep Trendelenburg Position

Abstract

Background. Robot-assisted laparoscopic radical prostatectomy (RLRP) can increase intracranial pressure (ICP) related to a change in position. Increasing ICP may result in various ocular complications, which are rare but serious, such as a corneal abrasion and ischemic optic neuropathy. We performed a prospective observational trial using ultrasonographic measurements to compare optic nerve sheath diameter (ONSD) related to ICP between patients who received either propofol or sevoflurane and underwent RLRP. Methods. Thirty-two male patients scheduled to undergo RLRP were assigned into groups according to the anesthetic agent used (group P: propofol, n = 16; group S: sevoflurane, n = 16). ONSD, end-tidal partial pressure of CO2, and blood pressure were measured 10 min after induction of anesthesia (T0), 30 min (T1), 60 min (T2), and 90 min after changing to the steep Trendelenburg position and introducing a pneumoperitoneum (T3) and 10 min after returning the patient’s position to supine (T4) during surgery. Results. No significant differences were observed in the demographic data of the patients, surgery time, or intraoperative variables, including hemodynamic and respiratory variables, at any of the time points. The mean right ONSDs in the propofol and sevoflurane groups were 37.3 and 40.1 mm at 30 min (p=0.003), respectively. The mean left ONSDs were 38.4 and 40.8 mm at 30 min (p=0.021) after changing to the Trendelenburg position. The ONSDs between the two groups were significantly different during surgery. Conclusions. ONSD increased more in the sevoflurane group than in the propofol group during RLRP. Intravenous anesthetics could alleviate the increase in ICP during RLRP.