Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?

Background: Robotic pelvic surgeries require steep Trendelenburg position which may result in rise in intraocular pressure (IOP).

Aim: The aim of this study was to compare the changes that occur in IOP during robotic pelvic surgeries in steep Trendelenburg position with a restrictive intravenous fluid administration.

Settings and Design: This prospective observational study was conducted in a tertiary care institution.

Subjects and Methods: Twenty consenting patients scheduled for pelvic robotic gynecological surgeries were enrolled. All patients received general anesthesia following a standardized protocol. IOP was measured before induction of anesthesia, immediately after induction and intubation, at the end of surgery immediately after making the patient supine and immediately after extubation. Ringer's lactate was administered intravenously at a rate of 4 mL/kg/h targeting a mean arterial pressure of >65 mmHg and urine output of >0.5 mL/kg/h.

Statistical Analysis Used: Paired t -test was used in this study.

Results: There was a fall in IOP soon after induction from baseline which was not significant. Immediately, following intubation, there was a significant rise in IOP. At the end of surgery, though IOP remained high, it was not statistically significant. However, following extubation, IOP rose further and the difference from the baseline became statistically significant. Although there was a moderate increase in peak airway pressure and highest EtCO2 levels during Trendelenburg from baseline values, the differences were statistically insignificant.

Conclusion: During robotic pelvic surgeries, adopting a restrictive intravenous fluid strategy with the maintenance of normal end-tidal carbon dioxide levels could abate effects of steep Trendelenburg position on IOP.