Background and goal of study: During pelvic laparoscopy, pneumoperitoneum and trendelenburg position may increase intraocular pressure (IOP) leading to decrease in perfusion of retina and at times the significant risk of ischemic retinopathy. The aim of our study is to compare the effects of desflurane and propofol for general anaesthesia on IOP and recovery in gynecological laparoscopic surgery.
Materials and Methods:Following approval of the local ethics committee, 60 female patients were randomized with sealed envelope method to two groups (Group P: Propofol, n=30) (Group D: Desflurane, n=30).Anaesthesia induction was performed with 0.5 mg/kg lidocaine, 2-3 mg/kg propofol, remifentanil 0.1-0.2 mcg/kg/h, 0.6 mg/kg rocuronium. Anaesthesia was maintained with desflurane + 50 %O2 + air, and 0.1-0.2 mcg/kg/h remifentanil iv  infusion in Group D or with propofol 4-12 mg/kg/h iv infusion + 50% O2 + air, and 0.1-0.2 mcg/kg/h remifentanil iv infusion in Group P. IOP was measured using Tono-Pen AVIA® applanation tonometer following topical anaesthesia, preoperatively (horizontal), 1 min after intubation, 1 min after pneumoperitoneum, 5 min after Trendelenburg position, 3 min after exsufflation, 3 min after extubation and 20 min after extubation in the recovery room. Hemodynamic and respiratory parameters were recorded. After extubation, in order to assess recovery and sedation in the PACU, Modified Aldrete Recovery Score (MARS) and Ramsey Sedation Scale (RSS) were used. Initial MARS and RSS scores after extubation were assessed in the operation room. MARS and RSS scores at the time of admission to PACU, and time to reach MARS ≥9 were recorded. 
Results: There was no significant difference in patient characteristics in two groups (p>0.05). The IOP was significantly lower at 1. min after pneumoperitoenum in Group P (p=0.022); however, there were no significant difference at all other times between groups (p>0.05). End of the operation, MARS was significantly higher in Group P (p<0.001). MARS in the recovery room was significantly higher in Group P (p<0.001). Time to reach MARS ≥9 was significantly shorter in Group P (p<0.001). End of the operation, RSS was significantly lower in Group P (p<0.001). 
Discussion and Conclusion: Propofol TIVA has an IOP taming effect and protects ocular perfusion during laparoscopy. Also, propofol is a superior agent regarding its effect on recovery in this surgery. Since our study was conducted on young population and in short-time surgery, further studies in different populations (older or patients with glaucoma etc.) are useful to understand the ocular effects of propofol and desflurane.

09 / Effects of inhalational anaesthesia and TIVA on intraocular pressure and recovery during gynecological laparoscopic surgery