Propofol attenuates the increase of sonographic optic nerve sheath diameter during robot-assisted laparoscopic prostatectomy: a randomized clinical trial

Abstract

Background: Robot-assisted laparoscopic prostatectomy (RALP) requires pneumoperitoneum and the Trendelenburg position to optimize surgical exposure, which can increase intracranial pressure (ICP). Anesthetic agents also influence ICP. We compared the effects of propofol and sevoflurane on sonographic optic nerve sheath diameter (ONSD) as a surrogate for ICP in prostate cancer patients who underwent RALP.

Methods: Thirty-six patients were randomly allocated to groups receiving propofol (propofol group, n = 18) or sevoflurane (sevoflurane group, n = 18) anesthesia. The ONSD was measured 10 min after induction of anesthesia in the supine position (T1); 5 min (T2), 30 min (T3), and 60 min (T4) after establishing pneumoperitoneum and the Trendelenburg position; and at the end of surgery after desufflation in the supine position (T5). Respiratory and hemodynamic variables were also evaluated.

Results: The ONSD was significantly different between the propofol group and the sevoflurane group at T4 (5.27 ± 0.35 mm vs. 5.57 ± 0.28 mm, P = 0.007), but not at other time points. The ONSDs at T2, T3, T4, and T5 were significantly greater than at T1 in both groups (all P < 0.001). Arterial carbon dioxide partial pressure, arterial oxygen partial pressure, peak airway pressure, plateau airway pressure, systolic blood pressure, pulse pressure variation, body temperature and regional cerebral oxygen saturation, except heart rate, were not significantly different between the two groups.

Conclusions: The ONSD was significantly lower during propofol anesthesia than during sevoflurane anesthesia 60 min after pneumoperitoneum and the Trendelenburg position, suggesting that propofol anesthesia may help minimize ICP changes in robotic prostatectomy patients.

Trial registration: Clinicaltrials.gov identifier: NCT03271502 . Registered August 31, 2017.

Keywords: Propofol; Robot-assisted laparoscopic prostatectomy; Sevoflurane; Sonographic optic nerve sheath diameter.

Fig. 1

Study flow diagram

Fig. 2

Comparison of the optic nerve sheath diameters between the propofol group and the sevoflurane group at 60 min after carbon dioxide pneumoperitoneum and a steep Trendelenburg position

Fig. 3

Comparisons of PaO₂ (a) PaCO₂ (b) peak airway pressure (c) plateau airway pressure (d systolic blood pressure (e) heart rate (f) pulse pressure variation (g) and body temperature (h) between the propofol group (blue circle) and the sevoflurane group (red circle) during robot-assisted laparoscopic prostatectomy. Note that all parameters except heart rate do not significantly differ between the two groups. PaCO₂ = arterial carbon dioxide partial pressure, PaO₂ = arterial oxygen partial pressure, T1 = 10 min after anesthetic induction in the supine position, T2 = 5 min after establishing carbon dioxide pneumoperitoneum and a steep Trendelenburg position, T3 = 30 min after establishing carbon dioxide pneumoperitoneum and a steep Trendelenburg position, T4 = 60 min after establishing carbon dioxide pneumoperitoneum and a steep Trendelenburg position, and T5 = at the end of surgery after desufflation of pneumoperitoneum in the supine position. * indicates P < 0.05 between the two groups; † indicates P < 0.01 between the two groups