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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 flu...

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Autores principales: Tosh, Pulak, Krishnankutty, Saritha Valsala, Rajan, Sunil, Nair, Hema Muraleedharan, Puthanveettil, Nitu, Kumar, Lakshmi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872854/
https://www.ncbi.nlm.nih.gov/pubmed/29628573
http://dx.doi.org/10.4103/aer.AER_144_17
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author Tosh, Pulak
Krishnankutty, Saritha Valsala
Rajan, Sunil
Nair, Hema Muraleedharan
Puthanveettil, Nitu
Kumar, Lakshmi
author_facet Tosh, Pulak
Krishnankutty, Saritha Valsala
Rajan, Sunil
Nair, Hema Muraleedharan
Puthanveettil, Nitu
Kumar, Lakshmi
author_sort Tosh, Pulak
collection PubMed
description 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 EtCO(2) 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.
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spelling pubmed-58728542018-04-06 Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure? Tosh, Pulak Krishnankutty, Saritha Valsala Rajan, Sunil Nair, Hema Muraleedharan Puthanveettil, Nitu Kumar, Lakshmi Anesth Essays Res Original Article 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 EtCO(2) 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. Medknow Publications & Media Pvt Ltd 2018 /pmc/articles/PMC5872854/ /pubmed/29628573 http://dx.doi.org/10.4103/aer.AER_144_17 Text en Copyright: 2018 © Anesthesia: Essays and Researches http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Tosh, Pulak
Krishnankutty, Saritha Valsala
Rajan, Sunil
Nair, Hema Muraleedharan
Puthanveettil, Nitu
Kumar, Lakshmi
Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?
title Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?
title_full Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?
title_fullStr Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?
title_full_unstemmed Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?
title_short Does Restrictive Fluid Strategy during Robotic Pelvic Surgeries Obtund Intraoperative Rise in Intraocular Pressure?
title_sort does restrictive fluid strategy during robotic pelvic surgeries obtund intraoperative rise in intraocular pressure?
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872854/
https://www.ncbi.nlm.nih.gov/pubmed/29628573
http://dx.doi.org/10.4103/aer.AER_144_17
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