Intraocular Pressure Changes during Gynecologic Laparoscopy in Patients Anesthetized with Propofol versus Desflurane

Park, Sang Hyun; Kim, Mi Hyun; Kim, Hee Jin; Park, Hee Pyoung; Jeon, Young Tae; Hwang, Jung Won

Abstract

BACKGROUND: Gynecologic laparoscopic surgery requires head-down position, so intraocular pressure can increase. It was reported that desflurane maintained low IOP values during anesthesia. The aim of this study was to investigate IOP changes after pneumoperitoneum with positional change from the supine position to head down under either desflurane or propofol anesthesia.
METHODS
Forty two patients scheduled for gynecologic laparoscopy were enrolled. They were randomly allocated into propofol and desflurane group. In the propofol group, anesthesia was induced and maintained with propofol. In the desflurane group, anesthesia was induced with thiopental sodium and maintained with desflurane. Ventilation was adjusted to maintain normocarbia and MBP, HR, peak inspiratory pressure, ETCO2, IOP of both eyes were measured at the following time points: awake supine position for baseline, after anesthetic induction, at 5 min, 10 min and 20 min after peumoperitoneum. At each time point, IOP of each eye was measured three times with the handheld tonometer (Tono-pen(R)XL) and mean value was recorded.
RESULTS
Different pattern of IOP change was shown between two groups. IOP decreased after induction and increased significantly after peumoperitoneum with head-down position in both group. In the desflurane group, however, IOP after pneumoperitoneum increased so highly and exceeded the preoperative IOP values (P < 0.001). In contrast, IOP of the propofol group kept similar to baseline value. A correlation was found between MAP and IOP values in the desflurane group.
CONCLUSIONS
In gynecologic laparoscopy, propofol may be a better choice rather than desflurane for the control of IOP during pneumoperitoneum.