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. 2023 Jun 12;12(1):23.
doi: 10.1186/s13741-023-00310-6.

The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial

Xiao-Yu Yang #  1 , Miao-Miao Wei #  1 , Hong Tan #  1 , Hai-Lian Wang  1 , Meng-Qiang Luo  2 , Ming Xu  1 , Ying-Wei Wang  3
Affiliations

The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial

Xiao-Yu Yang et al. Perioper Med (Lond). .

Abstract

Background: Elevated intraocular pressure (IOP) and optic nerve edema occurring during prone surgeries may cause ocular and optic nerve ischaemia injury. We hypothesized that a liberal fluid protocol might further increase IOP and optic nerve sheath diameter (ONSD) than a restrictive fluid protocol for patients in the prone position.

Methods: A single-centre, prospective and randomized trial was conducted. Patients were randomly allocated into 2 groups: the liberal fluid infusion group, in which repeated bolus doses of Ringer's lactate solution were given to maintain pulse pressure variation (PPV) within 6~9%, and the restrictive fluid infusion group, where PPV was maintained within 13-16%. IOP and ONSD were measured in both eyes at 10min after the anaesthesia induction in the supine position, 10min after the prone position placement, and 1h and 2h since the prone position was placed, at the conclusion of surgery, and returned to the supine position.

Results: A total of 97 patients were recruited and completed the study. IOP increased significantly from 12±3mmHg in the supine position to 31±5 mmHg (p<0.001) at the end of surgery in the liberal fluid infusion group and from 12±2 to 28±4 mmHg (p<0.001) in the restrictive fluid infusion group. There was a statistically significant difference in the change of IOP over time between the two groups (p=0.019). ONSD increased significantly from 5.3±0.3mm in the supine position to 5.5±0.3mm (p<0.001) at the end of surgery in both groups (both p<0.001). There was no statistically significant difference in the change of ONSD over time between the two groups (p>0.05).

Conclusions: Compared to the restrictive fluid protocol, the liberal fluid protocol increased IOP but not ONSD in patients undergoing prone spine surgery.

Trial registration: The study was registered in ClinicalTrials.gov ( https://clinicaltrials.gov ) prior to patient enrollment, ID: NCT03890510, on March 26, 2019. The principal investigator was Xiao-Yu Yang.

Keywords: Fluid therapy; Intraocular pressure; Optic nerve; Postoperative complications; Prone position.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study workflow
Fig. 2
Fig. 2
(1) IOP changes in the prone position of the low PPV group (liberal fluid infusion group) and the high PPV group (restrictive fluid infusion group). The significant difference over time between groups. (2) ONSD changes in the prone position of the low PPV group (liberal fluid infusion group) and high PPV group (restrictive fluid infusion group). No significant difference over time between groups. IOP intraocular pressure. PPV pulse pressure variation. ONSD optic nerve sheath diameter. **p<0.01 compared to baseline, ***p<0.001 compared to baseline; ^p<0.05 compared to the low PPV group, ^^p<0.01 compared to the low PPV group
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