The Influence of Prone Position for Spinal Surgery on Visual Acuity

NCT03644641 — Not applicable, Not yet recruiting, 60 participants, University Hospital Hradec Kralove

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The Influence of Prone Position for Spinal Surgery on Visual Acuity, a Comparison of Volatile Anesthesia With Desflurane to Total Intravenous Anesthesia With Propofol

Registry	NCT03644641
Status	Not yet recruiting
Phase	Not applicable
Study type	Interventional; randomized, parallel, masking: triple, treatment
Enrollment	60 (Estimated)
Sponsor	University Hospital Hradec Kralove (Other)
Conditions	Vision; Disorder, Loss
Interventions	Desflurane Group, Propofol Group (Procedure)
Dates	start 2025-11-28 (estimated), primary completion 2028-11-30 (estimated), completion 2029-12-30 (estimated), first posted 2018-08-23, last updated 2024-05-10
Locations	1 site in Czechia

-Summary

This study investigated the effect of desflurane and propofol anesthesia on visual acuity in patients in prone position for spinal surgery. Many trials have investigated the effects of different anesthetic agents on intraocular pressure, propofol may reduce intraocular pressure more than other intravenous anesthetics.

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+Detailed description

Perioperative increase in intraocular pressure can be caused by prone positioning. In addition to surgical factors, patients with glaucoma, uncontrolled hypertension, arthrosclerosis, and morbid obesity are at risk for potentially damaging optic nerve and loss of optic nerve function. Some studies found that intraocular pressure values were significantly lower in patients undergoing propofol total intravenous anesthesia than in patients undergoing desflurane anesthesia during intraoperative positional changes. Pronounced vasodilatation caused by desflurane might produced hyperaemia with higher intraocular pressure. Hemodynamic response to prone position measured by near-infrared spectroscopy (NIRS) on the prefrontal cortex could determine changes caused by prone position.

+Arms and interventions

Arm	Type	Interventions	Description
Desflurane Group	Experimental	Procedure: Desflurane Group	Induction and anesthesia will be held by using desflurane
Propofol Group	Experimental	Procedure: Propofol Group	Induction and anesthesia will be held by using target-control anesthesia with propofol

Desflurane Group (Procedure): General anesthesia will be held using desflurane in end- tidal concentration according to target value of entropy levels (between 40 and 60).
Propofol Group (Procedure): General anesthesia will be held using Schnider effect model for propofol (target control anesthesia). Titration will be done according to target value of entropy levels (between 40 and 60).

+Outcome measures

Primary outcomes

Visual injury [48 hours]: worsening of test for visual acuity (Rodenstock)

+Eligibility

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Glasgow Coma scale 15
* American Society of Anesthesiologists (ASA) Physical Status Classification System I-III
* spinal surgery in duration less than 3 hours
* sinus rhythm

Exclusion Criteria:

* postoperative artificial ventilation
* serious neurological disease
* lung disease with hypercapnia
* propofol allergy

+Locations (1)

Facility	City	Country	Status
University Hospital Hradec Kralove	Hradec Králové	Czechia

+Investigators

Pavel Dostal, MD, Ph.D., Study director, Hradec Kralove, Czechia 50005