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M. G. Uva, M. Astuto, V. Di Benedetto, A. Longo, M. Reibaldi, C. Stissi, C. Minardi, A. Reibaldi; The Effect of Pneumoperitoneum and Trendelemburg on Intraocular Pressure During Laparoscopic Surgery in Paediatric Patients. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2099. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the changes of intraocular pressure (IOP) during laparoscopic surgery in paediatric patients.
Sixteen patients (14 m. 2 f.; age 15-195 months, mean 96±61; weight 13-58 kg, mean 29±17) that underwent elective laparoscopic abdominal surgery in general anaesthesia were included in the study. All aged >1 year, had ASA I or II; patients with cardiovascular or respiratory disease, or with any ocular pathology, treatment or previous surgery were excluded. The study was approved by the Institutional Review Board; informed consent was obtained by parents and also by patients aging >6 yrs. All patients received a previous ophthalmic examination (anterior segment biomicroscopy, fundus examination in mydriasis). Anaesthesiological procedures included intravenous (propofol) or inalatory (sevofluorane) induction, and maintenance with air-oxygen, sevofluorane or TIVA. Patients, after carbon dioxide pneumoperitoneum was introduced, were placed in Trendelemburg position (5-10 degrees), maintained during the surgery. Intra Abdominal Pressure (IAP) was maintained <15 mmHg. At the end of the surgery, pneumoperitoneum was evacuated and patients were returned to horizontal position. Systolic and diastolic blood pressures (BPs), heart rate (HR), Saturation pressure O2 (SpO2), end-tidal CO2 (EtCO2), pulmonary arterial pressure (PAP), IAP and IOP were measured: - in supine: before induction, after induction (mechanically ventilated), after pneumoperitoneum introduction; - in trendelemburg: after 5, 10, 15 and 30 minutes; - in supine: after pneumoperitoneum evacuation, after extubation. IOP was measured in one eye by Perkins applanation tonometer.
No changes were seen in BPs, HR, SpO2, EtCO2, PAP, while IOP changed significantly (ANOVA p=0.000). Mean IOP (mmHg) (before induction 13.19+1.94) was decreased by the induction (to 10.63+2.50); compared with post-induction value, pneumoperitoneum introduction and trendelemburg position increased significantly the IOP (respectively to 12.88+2.45 and 14.38+2.13 at 5 minutes, both Tukey-Kramer p<0.01). IOP decreased after pneumoperitoneum evacuation (11.50+1.93) and recovered (13.56+1.86) after extubation.
Pneumoperitoneum and trendelemburg increase significantly the IOP from post-induction value, but IOP in healthy subjects remains in normal range. Caution should be used in subjects with suspect or manifest congenital glaucoma.
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