Double-blind comparison of lidocaine, tubocurarine and diazepam pretreatment in modifying intraocular pressure increases

The effect of mivacurium pretreatment on intra‐ocular pressure changes induced by suxamethonium

“…Therefore, there is a need for a method that can successfully prevent suxamethonium‐induced increases in intra‐ocular pressure. There have been reports that pretreatment with nondepolarising neuromuscular blockers [4, 9], diazepam [18–20], lignocaine [7, 21], nifedipine [22] and, more recently, alfentanil [23] may prevent increased intra‐ocular pressure, although this is not a universal finding [5–8, 20, 21, 24, 25]. It should be noted that all these studies were conducted using thiopentone as the intravenous induction agent.…”

“…We found that pretreatment with mivacurium markedly blunted the increase in intra‐ocular pressure after suxamethonium. It should be noted that some studies [5–8] have shown that nondepolarising neuromuscular blockers are ineffective in preventing the intra‐ocular pressure response to suxamethonium. There are several possible explanations for our findings.…”

“…This induction technique is known to cause a lower intra‐ocular pressure and a more obtunded haemodynamic response [26], which may have influenced the intra‐ocular pressure response to suxamethonium. Secondly, the nondepolarising blockers used in previous studies were tubocurarine, gallamine and pancuronium [5–8]. There have been no previous studies of the use of mivacurium in this context.…”

“…Many drugs have been used in an attempt to attenuate the increase in intra‐ocular pressure in response to suxamethonium. Nondepolarising neuromuscular blocking drugs such as tubocurarine, gallamine and pancuronium have been studied but the results have been conflicting [4–9]. Mivacurium is a short‐acting nondepolarising neuromuscular blocking drug that has not been evaluated for the purpose of reducing suxamethonium‐induced increased intra‐ocular pressure.…”

Effects of timolol ophthalmic solution on the intra‐ocular pressure rise induced by suxamethonium and tracheal intubation

“…Diverse approaches to the problem have included pretreatment with nondepolarising muscle relaxants [S], small 'self-taming' doses of suxamethonium [6], and the use of drugs as dissimilar as diazepam [7, 81, hexafluorenium [ 141, acetazolamide [ 151, propranolol [ 1 I] and intravenous lignocaine [3,9]. The mechanisms by which IOP is thought to rise acutely during anaesthesia relate primarily to external compression of the globe and to changes in intra-ocular volumes of aqueous humour and blood.…”