IOP Changes With Different Anesthetic Agents During Laparoscopic Colorectal Surgery
Condition: Intraocular Pressure
Study type: Interventional

Summary: 
      This study is aimed to evaluate how intraocular pressure (IOP) is changed depending on
      surgical position (Trendelenburg versus reverse Trendelenburg) in the same patient and to
      compare the effects of different anesthetics on IOP (desflurane versus propofol) in patients
      undergoing laparoscopic colorectal surgery. The study design is a double-blind randomized
      controlled trial. The patients were randomly assigned to desflurane or propofol administrated
      groups and all patient are administered intravenous remifentanil continuously as adjuvant
      analgesics during anesthesia. For this study 50 to 80-year-old patients undergoing
      laparoscopic colorectal surgery without eye disease were enrolled. Mean arterial blood
      pressure, peak airway pressure, end tidal carbon dioxide, and IOP (using a Tono-pen® Avia
      tonometer) on both eyes were measured at defined intervals during the procedure.
    

Detailed description: 
      Perioperative visual loss is a rare but devastating complication associated with certain type
      of operative procedures. Laparoscopic or robotic surgeries for colorectal cancer, prostate
      cancer and diseases of the female genital organs in the pelvic cavity are performed in a
      steep Trendelenburg position and pneumoperitoneum, which increases the intraocular pressure
      (IOP) by 13-26 mmHg compared with the preoperative IOP value. High intraocular pressure is
      believed to correlate with decreased perfusion to the optic nerve, and thus could lead to
      ischemic optic neuropathy. The objective of the study is to test which anesthetic agent
      (desflurane or propofol) can attenuate the changes in IOP during laparoscopic colorectal
      surgery and identify correlated parameters. Fifty patients (30-80 years; American Society of
      Anesthesiologists' physical status 1-2) scheduled for laparoscopic colorectal surgery will be
      enrolled and allocated randomly into two groups (group D and group P). After measurement of
      initial IOP with topical opthalmic anesthetics, general anesthesia will be induced with
      pentothal sodium 5-6mg/kg (group D) or propofol (group P) 2-2.5mg/kg. After administration of
      muscle relaxant and intubation, intraocular pressure will be measured and anesthesia will be
      maintained with desflurane (group D) or propofol (group P) and all patients will be
      administered intravenous remifentanil concurrently during anesthesia. During anesthesia, IOP
      will be measured at different patient positions. At the time of each IOP measurements, the
      following data set will be collected: mean arterial pressure (MAP), End tidal carbon dioxide
      (EtCO2), peak inspiratory pressure (PIP).
    

Intervention name(s): Desflurane; Propofol
Intervention type(s): Drug; Drug
Intervention description(s): On arrival in the operating room, initial intraocular pressure is measured after administration of alcaine 0.5% eye drop and routine monitoring and bispectral index(BIS) are applied. Anesthesia is induced with pentothal sodium inj (thiopental sodium 0.53g) 5-6mg/kg and esmeron inj (rocuronium bromide 50mg/5ml) 1mg/kg. Then endotracheal intubation is performed, anesthesia is maintained with 50% oxygen-air-4~7% desflurane inhalation and intravenous remifentanil continous infusion (effect site concentration 3-6ng/mL) during operation. Desflurane concentration is titrated to maintain BIS values within a target range 40-60 during operation. Mean arterial blood pressure, peak airway pressure, end tidal carbon dioxide, and IOP on both eyes are measured at defined intervals.; On arrival in the operating room, initial intraocular pressure is measured after administration of alcaine 0.5% eye drop and routine monitoring and bispectral index(BIS) are applied. Anesthesia is induced with fresofol MCT 1% inj (1% propofol) 1.5-2.5mg/kg and esmeron inj (rocuronium bromide 50mg/5ml) 1mg/kg. Then endotracheal intubation is performed, anesthesia is maintained with intravenous fresofol MCT 2% inj (2% propofol, effect site concentration 2.5-5μg/mL) and remifentanil (effect site concentration 3-6ng/mL) continous infusion. Effect site concentration of propofol is titrated to maintain BIS values within a target range 40-60 during operation. Mean arterial blood pressure, peak airway pressure, end tidal carbon dioxide, and IOP on both eyes are measured at defined intervals.
Other intervention name(s): Suprane soln. 240ml/Bottle; Fresofol medium-chain triglyceride (MCT) 2% inj. 50mL
Intervention MeSH terms: Propofol; Desflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Supportive Care
Keywords: intraocular pressure; trendelenburg position; pneumoperitoneum