Changes in intraocular pressures associated with inhalational and mixed anesthetic agents currently used in ophthalmic surgery

Abstract

Purpose: The aim of this study was to measure changes in intraocular pressures (IOPs) associated with inhalational and mixed anesthetic agents currently used for general anesthesia (GA) in ophthalmic surgery. Methods: In a cross-sectional study, 48 eyes from 48 consecutive subjects that underwent ophthalmic surgery under GA were included. Mixed anesthetics were used in 26 eyes and sevoflurane in 22 eyes. IOPs of the nonsurgery eyes were recorded at T1 (5 min before induction of anesthesia), T2 (5 min after intubation), and T3 (at the conclusion of surgery before extudation) using ICare PRO and Perkins tonometers. Linear mixed-effects models were used to compare differences in IOPs at various time points. Outcome measures were changes in IOP after induction of GA, intubation, and just before extubation and comparisons of decreases in IOPs induced by sevoflurane and mixed anesthetics. Results: Mean preanesthesia IOP for patients in this study (mean age ± standard deviation = 26.9 ± 18.3 years; range: 5–70 years) was 17.9 ± 4.9 (range: 10–30) mm Hg. There was a significant decrease in the mean IOP (standard error (SE) (in mm Hg) at T2 (Perkins: –4.65 (0.57); ICare PRO: –5.16 (0.56) and T3 (Perkins: –5.63; ICare PRO: –5.36) as compared to the IOP at T1 ( P < 0.001 ). The decreases in IOPs at T2 and T3 were similar in both anesthetic groups (T2: P = 0.60 ; T3: P = 0.33 ). Conclusion: Significant decreases in IOPs after GA were observed and the differences were not significantly different between sevoflurane and mixed anesthetic agents. For management decisions in pediatric glaucoma, the IOP measurements under GA are crucial, the underestimation of IOP as noted with currently used anesthetic agents has to be accounted for and decisions are taken appropriately.

Does Practitioner Experience Affect Intraocular Pressure After Endotracheal Intubation?

“…In our study, as compatible with other studies, IOP values were found to be low after induction and high after intubation compared to pre-induction values in less than three-year assistant groups [ 1 , 2 , 10 , 11 ]. This increase in IOP is within normal limits.…”

“…Tracheal intubation can cause an increase in intracranial pressure, which can lead to an increase in IOP. However, it is important to note that the effect of IOP can vary greatly between patients and depends on several factors, such as the individual's anatomy and the method of intubation [ 1 , 2 , 10 , 11 ].…”

Treatment Outcomes of Primary Combined Trabeculotomy With Trabeculectomy in Early Onset Glaucoma With Sturge-Weber Syndrome

“…The upper limit of IOP for success was 21 mm Hg or less when recorded under topical anesthesia and 16 mm Hg or less when under general anesthesia. The IOP criterion for success was lower when measured under general anesthesia (to account for IOP lowering by inhalational anesthetics) 32–34 …”

“…The primary outcome measure was success, defined as a complete success if the final IOP was > 5 mm Hg and ≤ 16 mm Hg under anesthesia without AGM or ≤ 21 mm Hg as recorded with Perkins tonometer under anesthesia or the Goldmann applanation tonometer in the clinic under topical anesthesia. [32][33][34] The outcome was defined as qualified success for similar IOP criteria with or without AGM. Eyes with uncontrolled IOP, those needing repeat surgery for IOP control, loss of light perception, or sight-threatening complications were considered failures.…”

“…The IOP criterion for success was lower when measured under general anesthesia (to account for IOP lowering by inhalational anesthetics). [32][33][34]…”