Abstract Introduction: Optic nerve sheath diameter (ONSD) serves as a reliable surrogate marker for intracranial pressure (ICP) during robotic assisted laparoscopic radical prostatectomies (RARP). ICP elevation is greater in patients above 60 years due to impaired cerebral autoregulation and compliance. While total intravenous anaesthesia with propofol has demonstrated better control over ONSD compared to inhalational anaesthetics, the latter’s dose-dependent vasodilatory effects on cerebral vessels remain understudied. This trial is aimed to compare the effects of isoflurane and desflurane on ONSD in elderly patients undergoing RARP. Secondary goals include incidence of neurological complications, delayed recovery and duration of hospital stay. Patients and Methods: A prospective randomised controlled study was conducted on 54 elderly patients aged 60 years and above, undergoing RARP. These patients were randomised to receive isoflurane or desflurane for maintenance of anaesthesia. ONSD measurements and hemodynamic parameters were obtained at baseline, during pneumoperitoneum and postoperatively. Recovery profiles, complications and duration of hospital stay were recorded. Data were analysed using the Pearson Chi-square test, independent sample t -test and Mann–Whitney test. Results: A total of 50 patients were analysed. While mean ONSD values were raised from baseline intraoperatively in both groups, values remained within normal limits without significant intergroup differences. ONSD values returned to baseline in all patients at the end of surgery. Neither group exhibited post-operative complications nor delayed recovery. Conclusion: Isoflurane and desflurane exhibit comparable and safe profiles in terms of ICP elevation during RARP. Both agents are effective for maintenance of anaesthesia in elderly patients requiring steep Trendelenburg positioning for RARP.
Rajmohan et al. (Mon,) studied this question.