Posición prona en nefrolitotomía percutánea y ceguera postoperatoria
Prone position in percutaneous nephrolithotomy and postoperative visual loss.
Agah M, Ghasemi M, Roodneshin F, Radpay B, Moradian S.
Urol J. 2011 Summer;8(3):191-6.
Abstract
PURPOSE:To study the simultaneous effects of prone position and anesthesia on intraocular pressure (IOP) and the time impact on post anesthesiavisual loss development in percutaneous nephrolithotomy (PCNL).MATERIALS AND METHODS:Twenty patients who were candidates for PCNL were recruited in this study. Intraocular pressure was measured in five occasions: 1. Base line; 2. Ten minutes after anesthesia (Supine-I); 3. Ten minutes after position change to prone (Prone-I); 4. At the end of the operation (Prone-II); and 5. Ten minutes after position change to supine (Supine-II). The data were analyzed by SPSS software using repeated measures ANOVA and paired t test. RESULTS:The participants consisted of 17 (85%) men and 3 (15%) women, with the mean age of 44 years. The duration of the prone position was 79.75 ± 22.73 minutes. Intraocular pressure changed significantly in five positions (P = .000). It was lower in supine-I than baseline, higher in prone-I than base line and supine-I, lower in supine-II than prone-II, and highest in prone-II (P = .000). There was a linear relationship between IOP and prone position duration (r = 0.67; P = .001).CONCLUSION: Intraocular pressure dropped significantly after anesthesia and increased in prone position. There was a linear relationship between IOP rise and the prone position duration, doubled within two hours. Therefore, in PCNL carried out in prone position, it is recommended to observe safety measures and necessary precautions for IOP rise and possible post anesthesia visual loss, particularly in glaucoma.
http://www.urologyjournal.org/index.php/uj/article/view/1131/564
El efecto de la posición prona sobre la presión intraocular en pacientes anestesiados
The effect of prone positioning on intraocular pressure in anesthetized patients.
Cheng MA, Todorov A, Tempelhoff R, McHugh T, Crowder CM, Lauryssen C.
Anesthesiology. 2001 Dec;95(6):1351-5.
Abstract
BACKGROUND:Ocular perfusion pressure is commonly defined as mean arterial pressure minus intraocular pressure (IOP). Changes in mean arterial pressure or IOP can affect ocular perfusion pressure. IOP has not been studied in this context in the prone anesthetized patient.
METHODS: After institutional human studies committee approval and informed consent, 20 patients (American Society of Anesthesiologists physical status I-III) without eye disease who were scheduled for spine surgery in the prone position were enrolled. IOP was measured with a Tono-pen XL handheld tonometer at five time points: awake supine (baseline), anesthetized (supine 1), anesthetized prone (prone 1), anesthetized prone at conclusion of case (prone 2), and anesthetized supine before wake-up (supine 2). Anesthetic protocol was standardized. The head was positioned with a pinned head-holder. Data were analyzed with repeated-measures analysis of variance and paired t test. RESULTS:Supine 1 IOP (13 +/- 1 mmHg) decreased from baseline (19 +/- 1 mmHg) (P < 0.05). Prone 1 IOP (27 +/- 2 mmHg) increased in comparison with baseline (P < 0.05) and supine 1 (P < 0.05). Prone 2 IOP (40 +/- 2 mmHg) was measured after 320 +/- 107 min in the prone position and was significantly increased in comparison with all previous measurements (P < 0.05). Supine 2 IOP (31 +/- 2 mmHg) decreased in comparison with prone 2 IOP (P < 0.05) but was relatively elevated in comparison with supine 1 and baseline (P < 0.05). Hemodynamic and ventilatory parameters remained unchanged during the prone period.
CONCLUSIONS:Prone positioning increases IOP during anesthesia. Ocular perfusion pressure could therefore decrease, despite maintenance of normotension.
http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2001&issue=12000&article=00012&type=abstract
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Prone position in percutaneous nephrolithotomy and postoperative visual loss.
Agah M, Ghasemi M, Roodneshin F, Radpay B, Moradian S.
Urol J. 2011 Summer;8(3):191-6.
Abstract
PURPOSE:To study the simultaneous effects of prone position and anesthesia on intraocular pressure (IOP) and the time impact on post anesthesiavisual loss development in percutaneous nephrolithotomy (PCNL).MATERIALS AND METHODS:Twenty patients who were candidates for PCNL were recruited in this study. Intraocular pressure was measured in five occasions: 1. Base line; 2. Ten minutes after anesthesia (Supine-I); 3. Ten minutes after position change to prone (Prone-I); 4. At the end of the operation (Prone-II); and 5. Ten minutes after position change to supine (Supine-II). The data were analyzed by SPSS software using repeated measures ANOVA and paired t test. RESULTS:The participants consisted of 17 (85%) men and 3 (15%) women, with the mean age of 44 years. The duration of the prone position was 79.75 ± 22.73 minutes. Intraocular pressure changed significantly in five positions (P = .000). It was lower in supine-I than baseline, higher in prone-I than base line and supine-I, lower in supine-II than prone-II, and highest in prone-II (P = .000). There was a linear relationship between IOP and prone position duration (r = 0.67; P = .001).CONCLUSION: Intraocular pressure dropped significantly after anesthesia and increased in prone position. There was a linear relationship between IOP rise and the prone position duration, doubled within two hours. Therefore, in PCNL carried out in prone position, it is recommended to observe safety measures and necessary precautions for IOP rise and possible post anesthesia visual loss, particularly in glaucoma.
http://www.urologyjournal.org/index.php/uj/article/view/1131/564
El efecto de la posición prona sobre la presión intraocular en pacientes anestesiados
The effect of prone positioning on intraocular pressure in anesthetized patients.
Cheng MA, Todorov A, Tempelhoff R, McHugh T, Crowder CM, Lauryssen C.
Anesthesiology. 2001 Dec;95(6):1351-5.
Abstract
BACKGROUND:Ocular perfusion pressure is commonly defined as mean arterial pressure minus intraocular pressure (IOP). Changes in mean arterial pressure or IOP can affect ocular perfusion pressure. IOP has not been studied in this context in the prone anesthetized patient.
METHODS: After institutional human studies committee approval and informed consent, 20 patients (American Society of Anesthesiologists physical status I-III) without eye disease who were scheduled for spine surgery in the prone position were enrolled. IOP was measured with a Tono-pen XL handheld tonometer at five time points: awake supine (baseline), anesthetized (supine 1), anesthetized prone (prone 1), anesthetized prone at conclusion of case (prone 2), and anesthetized supine before wake-up (supine 2). Anesthetic protocol was standardized. The head was positioned with a pinned head-holder. Data were analyzed with repeated-measures analysis of variance and paired t test. RESULTS:Supine 1 IOP (13 +/- 1 mmHg) decreased from baseline (19 +/- 1 mmHg) (P < 0.05). Prone 1 IOP (27 +/- 2 mmHg) increased in comparison with baseline (P < 0.05) and supine 1 (P < 0.05). Prone 2 IOP (40 +/- 2 mmHg) was measured after 320 +/- 107 min in the prone position and was significantly increased in comparison with all previous measurements (P < 0.05). Supine 2 IOP (31 +/- 2 mmHg) decreased in comparison with prone 2 IOP (P < 0.05) but was relatively elevated in comparison with supine 1 and baseline (P < 0.05). Hemodynamic and ventilatory parameters remained unchanged during the prone period.
CONCLUSIONS:Prone positioning increases IOP during anesthesia. Ocular perfusion pressure could therefore decrease, despite maintenance of normotension.
http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2001&issue=12000&article=00012&type=abstract
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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