1
|
Ripa M, Schipa C, Kopsacheilis N, Nomikarios M, Perrotta G, De Rosa C, Aceto P, Sollazzi L, De Rosa P, Motta L. The Impact of Steep Trendelenburg Position on Intraocular Pressure. J Clin Med 2022; 11:jcm11102844. [PMID: 35628970 PMCID: PMC9146028 DOI: 10.3390/jcm11102844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Intraocular pressure occurring during the Trendelenburg position may be a risk for postoperative visual loss and other ocular complications. Intraocular pressure (IOP) higher than 21 mmHg poses a risk for ocular impairment causing several conditions such as glaucoma, detached retina, and postoperative vision loss. Many factors might play a role in IOP increase, like peak expiratory pressure (PIP), mean arterial blood pressure (MAP), end-tidal CO2 (ETCO2) and surgical duration and some others (anaesthetic and neuromuscular blockade depth) contribute by reducing IOP during procedures requiring both pneumoperitoneum and steep Trendelenburg position (25–45° head-down tilt). Despite transient visual field loss after surgery, no signs of ischemia or changes to the retinal nerve fibre layer (RNFL) have been shown after surgery. Over the years, several studies have been conducted to control and prevent IOPs intraoperative increase. Multiple strategies have been proposed by different authors over the years to reduce IOP during laparoscopic procedures, especially those involving steep Trendelenburg positions such as robot-assisted laparoscopic prostatectomy (RALP), and abdominal and pelvic procedures. These strategies included both positional and pharmacological strategies.
Collapse
Affiliation(s)
- Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
| | - Chiara Schipa
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-3290730977
| | - Nikolaos Kopsacheilis
- East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital Ethelbert Road, Canterbury CT1 3NG, UK;
- New Hayesbank Ophthalmology Services, Cemetery Lane, Kennington, Ashford TN24 9JZ, UK
| | - Mikes Nomikarios
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.N.); (L.M.)
| | - Gerardo Perrotta
- GI Surgery Department, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Carlo De Rosa
- Department of Ophthalmology, A. Cardarelli Hospital, 80131 Naples, Italy; (C.D.R.); (P.D.R.)
| | - Paola Aceto
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Liliana Sollazzi
- Catholic University “Sacro Cuore”, 00135 Rome, Italy; (P.A.); (L.S.)
- Department of Emergency, Anesthesiological and Reanimation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Pasquale De Rosa
- Department of Ophthalmology, A. Cardarelli Hospital, 80131 Naples, Italy; (C.D.R.); (P.D.R.)
| | - Lorenzo Motta
- Department of Ophthalmology, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford TN24 0LZ, UK; (M.N.); (L.M.)
| |
Collapse
|