Intraocular Pressure Elevation During Laparoscopic Hysterectomy of Patients in the Steep Trendelenburg Position Under Propofol Anesthesia

Abstract

Objective: To evaluate the intraocular pressure (IOP) during laparoscopic hysterectomy of patients in the steep trendelenburg (ST) position under propofol anesthesia. Methods: Seventy female patients, without history of ocular pathology, undergoing elective laparoscopic hysterectomy, were randomly assigned to control (Con) group or dexmedetomidine (Dex) group. The Dex group was treated with a loading dose of Dex (1 μg/kg), infusing intravenously over 15 min, followed by continuous infusion of Dex (0.4 μg/kg/h) until the end of procedure. The Con group received an equal volume of normal saline. IOP was measured three times in each eye at 11 different time points. Intraoperative data, mean arterial pressure, heart rate, and end-tidal CO2, total dose of propofol and remifentanil were measured. Results: The IOP was increased in a time dependent manner following anesthesia induction until the end of surgery period under the ST position (T3–T8), while this tendency was depressed by Dex at T7 (p = 0.024) and T8 (p = 0.004) points as compared to the Con group. IOP was declined in the Dex group at 5 and 60 min after tracheal extubation (p = 0.000 and p = 0.007, respectively). Compared with T1 point, the IOP recovered to the baseline in the Dex group at T10 point (p = 0.235), but not in the Con group (p = 0.009). Conclusions: IOP can be controlled to a certain level in patients undergo laparoscopic hysterectomy in the ST position when receiving propofol combined with Dex which can also promote the IOP recovery to the preoperative level during the immediate post-tracheal extubation period.