Seeking guidance about anesthesia when patient has glaucoma and needs to have prostate surgery
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5 months ago
Alice • 10

What anesthesia should be avoided if the patient needs to undergo prostate surgery but suffers from glaucoma? Thank you for your thoughtful guidance.

glaucoma surgery anesthesia • 122 views
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5 months ago
david 3.2k

This seems like a complex question and I am not the most qualified person to answer it. However, I'll offer what I can. The factors that can influence intraocular pressure during anesthesia include the positioning of the patient's body, respiratory and circulatory parameters and the duration of the surgery. Glaucoma status is a factor too, of course.

In the study "Changes in intraocular pressure and optic nerve sheath diameter in patients undergoing robotic-assisted laparoscopic prostatectomy in steep 45° Trendelenburg position" the investigators point out that intraocular pressure doubled during surgery.

They also point out that visual function was not significantly impaired postoperatively. However, in my opinion, that statement could give a false sense of comfort. In my view the parameters they reported indicated they are playing with fire and it may have been pure luck that prevented any of these patients from suffering visual field damage.

The 2018 paper "Physiology and Role of Intraocular Pressure in Contemporary Anesthesia" states:

Anesthetic management significantly influences the pressure changes in the eye throughout the perioperative period.

My suggestion would be to point the patient's medical team to the above two papers and pay close attention to their reaction to this discussion with you. I have experience with a surgeon who thanked me for providing him with printed studies he had not seen and assured me he would read them. I could tell by his reaction that he would do so.


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