Effect of gynecological laparoscopy on intraocular pressure in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia

ABSTRACT

To evaluate the effect of gynecological laparoscopy on intraocular pressure changes in patients anesthetized with propofol total intravenous anesthesia in comparison to isoflurane inhaled anesthesia. This is a prospective randomized clinical study was done in the departments of Obstetrics and Gynaecology, Sohag University Hospital. Thirty patients underwent an elective gynecological laparoscopy were recruited in this study after fulfilling the inclusion criteria. Patients were divided randomly into two groups; propofol group [n=15] and isoflurane group [n=15]. MAP, HR, peak and plateau airway pressures [Paw], ETco2 and IOP were recorded at the following time points. Tl before the induction of anesthesia, T2 before pneumoperitoneum, T3 after pneumoperitoneum, T4 at 15°-20° head-down tilt, T5 After return to the horizontal position, T6 after the pneumoperitoneum had been evacuated and lastly T7 in the recovery room, 20 minute after tracheal extubation. Both groups were comparable as regard to their age, body mass index [BMI], duration of the procedure and the preoperative IOP. There were no significant differences in MAP or HR between both groups. After induction of anesthesia, IOP decreased significantly in propofol group [P<0.01] than isoflurane group [P<0.05]. In the isoflurane group, there was a significant increase in IOP after pneumoperitoneum [T3 versus T2, P< 0.05]. Also there was a significant increase in the IOP after head-down position [T4 versus T2, P< 0.01], which exceeded the preoperative IOP value [T4 versus Tl]. In the propofol group, IOP insignificantly increased after pneumoperitoneum and with head-down position. IOP in propofol group was at all times less than isoflurane group. In the recovery room, IOP returned to baseline in the Isoflurane group, but remained insignificantly lower in the propofol group. There was no significant correlation between MAP, HR, IOP values and plateau airway pressures in both groups. Laparoscopic gynecologic surgery with head down position increases IOP within the normal diurnal range. propofol TIVA has an IOP controlling effect during laparoscopy and may be preferred if control of IOP is a must before laparoscopy