Abstract:

The aim of our study was to compare intraoperative changes on the haemodynamics and intraocular pressure in the head-up and head-down position in laparoscopic cholecystectomy and gynaecologic surgery. This cohort study (prospective observational study) was made in Antalya Education and Research Hospital (Turkey) between 2015 and 2017. Seventy seven patients undergoing laparoscopic cholecystectomy (head-up position, n=42 ) and laparoscopic gynecology operations (head-down position=35) were included. The intraocular pressure (IOP) was measured for both eyes at defined intervals during the procedure with Schiotz tonometer. During of surgery, heart rate, mean arterial blood pressure, sistolic arterial blood pressure, diastolic arterial blood pressure and ETCO2 were also recorded. IOP was detected to be higher in Group II at the 5th minute of CO2 insufflation (17.17±2.91) and at the 5th minute of head-down position (17.97±2.83), P<0.05. In addition, IOP measurements were recorded 14.79±4.92 for group I and 17.17±3.03 for group II significally higher immediately before post-op CO2 desufflation (P<.0.05). Statistically meaningful difference was detected between groups in terms of operation and anaesthesia processes (P=0.044, P<0.001 respectively). The patient’s position during surgery may represent a stronger risk factor for IOP increase than pneumoperitoneum-related intraabdominal pressure in surgical operations which are expected to last longer than two hours and in old patients. IOP increases with head-down position. We recommend preoperative and peroperative IOP measurement in laparascopic and robotic surgery attempts, in surgical operations which are expected to last long and in old patients whether or not they have eye disease anamnesis.

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