J Korean Med Sci.  2016 Jun;31(6):989-996. 10.3346/jkms.2016.31.6.989.

Effects of Systemic Administration of Dexmedetomidine on Intraocular Pressure and Ocular Perfusion Pressure during Laparoscopic Surgery in a Steep Trendelenburg Position: Prospective, Randomized, Double-Blinded Study

• Joo J
• Koh H
• Lee K
• Lee J

• KMID: 2373711
• DOI: http://doi.org/10.3346/jkms.2016.31.6.989

Abstract

Increased intraocular pressure (IOP) during surgery is a risk factor for postoperative ophthalmological complications. We assessed the efficacy of systemically infused dexmedetomidine in preventing the increase in IOP caused by a steep Trendelenburg position, and evaluated the influence of underlying hypertension on IOP during surgery. Sixty patients undergoing laparoscopic surgery in a steep Trendelenburg position were included. Patients in the dexmedetomidine group received a 1.0 µg/kg IV loading dose of dexmedetomidine before anesthesia, followed by an infusion of 0.5 µg/kg/hr throughout the operation. Patients in the saline group were infused with the same volume of normal saline. IOP and ocular perfusion pressure (OPP) were measured 16 times pre- and intraoperatively. In the saline group, IOP increased in the steep Trendelenburg position, and was 11.3 mmHg higher at the end of the time at the position compared with the baseline value (before anesthetic induction). This increase in IOP was attenuated in the dexmedetomidine group, for which IOP was only 4.2 mmHg higher (P < 0.001 vs. the saline group). The steep Trendelenburg position was associated with a decrease in OPP; the degree of decrease was comparable for both groups. In intragroup comparisons between patients with underlying hypertension and normotensive patients, the values of IOP at every time point were comparable. Dexmedetomidine infusion attenuated the increase in IOP during laparoscopic surgery in a steep Trendelenburg position, without further decreasing the OPP. Systemic hypertension did not seem to be associated with any additional increase in IOP during surgery. (Registration at the Clinical Research Information Service of Korea National Institute of Health ID: KCT0001482)

Keyword

Dexmedetomidine; Intraocular Pressure; Ocular Perfusion Pressure; Trendelenburg Position

MeSH Terms

Aged
Dexmedetomidine/administration & dosage/*pharmacology
Double-Blind Method
Eye Diseases/surgery
Female
Head-Down Tilt
Humans
Hypnotics and Sedatives/administration & dosage/pharmacology
Intraocular Pressure/*drug effects
Intraoperative Complications/drug therapy/prevention & control
Laparoscopy
Male
Middle Aged
Prospective Studies
Risk Factors
Tonometry, Ocular
Treatment Outcome
Dexmedetomidine
Hypnotics and Sedatives

Figure

• 

  Fig. 1 COMSORT flow diagram to illustrate the study design.

• 

  Fig. 2 Comparison of intraocular pressure (A) and ocular perfusion pressure (B) between groups. T1 = before anesthetic induction; T2 = before administration of the study drug; T3 = after administration of anesthetic induction agents; T4 = immediately after tracheal intubation; T5-T8 = 1, 3, 5, and 10 minutes after tracheal intubation; T9 = immediately after intraperitoneal CO2 insufflation; T10 = immediately after steep Trendelenburg position; T11-T13 = 1, 2, and 4 h after onset of steep Trendelenburg position; T14 = just before supine position; T15, T16 = 10 and 30 minutes after supine position. IOP = intraocular pressure, OPP = ocular perfusion pressure. *Bonferroni correction for multiple comparisons, adjusted P value for significance P < 0.003.

• 

  Fig. 3 Comparisons of intraocular pressure between normotensive and hypertensive patients in saline (A) and dexmedetomidine (B) groups. Time values indicated by T1 through T16 are as in Fig. 2. IOP = intraocular pressure.

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  Fig. 4 (A and B) Correlations between peak inspiratory pressure and intraocular pressure. r = 0.881 and 0.739, respectively, for saline (A) and dexmedetomidine groups (B); P < 0.001. (C and D) Correlations between mean inspiratory pressure and intraocular pressure. r = 0.812 and 0.739, respectively, for saline (C) and dexmedetomidine (D) groups; P < 0.001.

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