The effects of desflurane and sevoflurane on the intraocular pressure associated with endotracheal intubation in pediatric ophthalmic surgery

Park, Jong Taek; Lim, Hyun Kyo; Jang, Kyu Yong; Um, Dea Ja

doi:10.4097/kjae.2013.64.2.117

Cited by 27 publications

(28 citation statements)

References 15 publications

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“…[7] On the other hand, no significant difference in IOP between the tracheal tube and LMA approaches. [13] Ayendi et al (2011) compared the impacts of I-gel and LMA Classic™ approaches between the two groups of 21 patients and concluded that the time of insertion in the I-gel group was shorter and the frequency of dysphagia after 1 hour postoperation was higher the LMA, whereas airway pressure was higher in the I-gel group. [14] Oczenski et al (2000) compared hemodynamic changes during the insertion of ETT, Combitube, and LMA in 75 patients and concluded that after insertion of ETT and The letter "a" indicates a significant difference with the rest.…”

Section: Discussionmentioning

confidence: 99%

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Akhondzade¹

2017

AJP

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Background and Objective: Hemodynamic changes following laryngoscopic tracheal intubation can trigger catecholamine release which consequently increases blood pressure and intraocular pressure (IOP) resulting in the disc rupture and ultimately blindness. Endotracheal intubation (endotracheal tube [ETT]) is a common technique for stress response management. The present study aims to comparatively investigate the hemodynamic changes and IOP after three intubation approaches of ETT, laryngeal mask airway (LMA) Classic™, and I-gel in patients undergoing elective cataract surgery. Materials and Methods: This clinical trial was conducted on 75 patients with ASA classes I and II (age range: 50-65 years old) who were the candidate for elective cataract surgery admitted in Ahvaz Imam Hospital, Iran, during 2013-2014. The hemodynamic changes and IOP values were measured in the patients before and after intubation with ETT, LMA Classic™, and I-gel. The pulse rate, systolic and diastolic blood pressures, and IOP were measured at four intervals at 1 minute before and at 1, 2, and 5 min after the insertion of the airway devices. The IOP was measured with Tonopen. Results: Immediately, before inserting ETT, LMA, and I-gel, the heart rate, systolic and diastolic blood pressures significantly increased in all groups. The results showed that the hemodynamic changes and IOP following I-gel were more stable than the LMA Classic™ and ETT devices. In addition, the LMA Classic™ intubation showed more stable hemodynamic response than the ETT. Conclusions: The findings showed that I-gel intubation results in more stable hemodynamic responses in elective cataract surgery.

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Section: Discussionmentioning

confidence: 99%

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Akhondzade¹

2017

AJP

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“…Therefore, it is important to know some of the purported mechanisms of the unpredictable and sometimes significant IOP elevations associated with endotracheal intubation. 63,177,187 Suggested explanations for IOP elevations with endotracheal intubation are as follows 1, 18,30,88,126,152 : 1) the actual stress of laryngoscopy and the passage of the endotracheal tube through the glottic aperture 30 can cause sympathetic stimulation, which can result in a rise in IOP, 1, 30,187 2) sympathetic stimulation may also affect vasoconstriction and increase central venous pressure, which can therefore increase IOP, 138,178 and 3) adrenergic stimulation may also increase resistance to aqueous humor outflow through the trabecular meshwork, resulting in a rise in IOP. 88 To compensate for potential IOP elevations associated with laryngoscopy and intubation, some studies suggest that the IOP elevation can be minimized with rocuronium, a muscle relaxant, 178 clonidine, 57,94 and dexmedetomidine premedication.…”

Section: Intubationmentioning

confidence: 99%

Pediatric intraocular pressure measurements: Tonometers, central corneal thickness, and anesthesia

Fayed

Chen

2019

Survey of Ophthalmology

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Measuring intraocular pressure (IOP) is the cornerstone of a comprehensive glaucoma examination. In babies or small children, however, IOP measurements are problematic, cannot often be performed at the slit lamp, and sometimes require general anesthesia. Therefore, it is essential for an ophthalmologist who examines a pediatric patient to be aware of the different tonometers used in children, as well as the effects of central corneal thickness and anesthesia on IOP measurements. Goldmann applanation tonometry is the gold standard for IOP assessment. Most alternative tonometers tend to give higher IOP readings than the Goldmann applanation tonometer, and readings between different tonometers are often not interchangeable. Similar to Goldmann tonometry, many of these alternative tonometers are affected by central corneal thickness, with thicker corneas having artifactually high IOP readings and thinner corneas having artifactually lower IOP readings. Although various machines can be used to compensate for corneal factors (e.g., the dynamic contour tonometer and ocular response analyzer), it is important to be aware that certain ocular diseases can be associated with abnormal central corneal thickness values and that their IOP readings need to be interpreted accordingly. Because induction and anesthetics can affect IOP, office IOPs taken in awake patients are always the most accurate.

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“…There was no significant difference in HR or blood pressure between adult sevoflurane (1-2%) and desflurane anesthesia (3-6%) groups provided with 60% nitrous oxide [30]. When 1 MAC sevoflurane was compared to 1 MAC desflurane in pediatric patients, there was no significant difference between the two groups in mean arterial blood pressure (MAP) or HR, except at 1 minute after tracheal intubation [28]. At that time, the desflurane group showed a significantly higher MAP and HR than the sevoflurane group.…”

Section: Discussionmentioning

confidence: 97%

“…Breath holding, excessive secretion, and desaturation occurred more frequently in desflurane anesthesia than sevoflurane anesthesia [8]. Surprisingly, in one report IV low-dose ketamine as premedication suppressed fentanylinduced cough [28]. Desflurane does not cause any significant changes in bronchial tone, while isoflurane and sevoflurane decrease airway resistance [19].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effects of desﬂurane and sevoﬂurane on emergence characteristics in pediatric patients premedicated with ketamine

Kim¹,

Lee²,

Park³

et al. 2021

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Objectives: Desflurane may be useful for ambulatory anesthesia. However, desflurane-induced airway irritability makes its use challenging, especially in children. Ketamine can be used to reduce separation anxiety and emergence agitation (EA). However, ketamine may increase bronchial secretions. This study compared desflurane with sevoflurane anesthesia, in terms of emergence time and EA, in preschool children with intravenous (IV) ketamine premedication. Methods: Fifty-six children were scheduled for elective epiblepharon surgery. In the waiting room, ketamine (1 mg/kg) was intravenously administered to patients to reduce separation anxiety. After transport to the operating room, general anesthesia was induced with sevoflurane. The anesthetic agent was changed to desflurane in the desflurane group (group D), while sevoflurane was continued in the sevoflurane group (group S) during surgery. Emergence time (time to gag reflex and time to extubation) and EA (measured using the Pediatric Anesthesia Emergence Delirium [PAED] scale) were compared between the two groups. Respiratory complications were also recorded. Results: Time to gag reflex (611.1 ± 288.9 s vs. 275.0 ± 126.7 s, P < 0.001) and time to extubation (756.3 ± 267.2 s vs. 425.9 ± 122.9 s, P < 0.001) were significantly shorter in group D than group S. EA did not differ between the two groups. There were no severe respiratory complications. Conclusions: Emergence time was shorter for desflurane anesthesia than sevoflurane anesthesia in preschool children who received IV ketamine premedication. Desflurane anesthesia with IV 0.1 mg/kg of ketamine premedication could be used safely in pediatric ophthalmic surgery; there were no significant respiratory events.

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The effects of desflurane and sevoflurane on the intraocular pressure associated with endotracheal intubation in pediatric ophthalmic surgery

Cited by 27 publications

References 15 publications

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Pediatric intraocular pressure measurements: Tonometers, central corneal thickness, and anesthesia

Comparison of the effects of desﬂurane and sevoﬂurane on emergence characteristics in pediatric patients premedicated with ketamine

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