Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

The effect of robotic surgery on intraocular pressure and optic nerve sheath diameter: a prospective study

Bedih Balkan, Nalan Saygi Emir, Bengi Demirayak, Halil Çetingok, Basak Bayrak

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Background and objectives
To investigate the effect of the steep Trendelenburg position (35° to 45°) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocular pressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparoscopic prostatectomy (RALP), and to evaluate possible correlations between these parameters.

A total of 34 patients were included in this study. ONSD was measured using ultrasonography and IOP was measured using a tonometer at four time points: T1 (5 minutes after intubation in the supine position); T2 (30 minutes after CO2 insufflation); T3 (120 minutes in steep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation). Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (et CO2) were also evaluated.

The mean IOP was 12.4 mmHg at T1, 20 mmHg at T2, 21.8 mmHg at T3, and 15.6 mmHg at T4. The mean ONSD was 4.87 mm at T1, 5.21 mm at T2, 5.30 mm at T3, and 5.08 at T4. There was a statistically significant increase and decrease in IOP and ONSD between measurements at T1 and T4, respectively. However, no significant correlation was found between IOP and ONSD. A significant positive correlation was found only between ONSD and diastolic arterial pressure. Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD.

A significant increase in IOP and ONSD were evident during RALP; however, there was no significant correlation between the two parameters.


Intraocular pressure;  Optic nerve sheath diameter;  Robotic-assisted laparoscopic prostatectomy;  Trendelenburg position;  Ultrasonography


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