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LETTER TO EDITOR
Year : 2007  |  Volume : 55  |  Issue : 2  |  Page : 164

Intraocular pressure changes after succinylcholine and endotracheal intubation: A comparison of thiopental and propofol on IOP


Department of Anesthesiology, Shiraz Medical Faculty, Shiraz University of Medical Sciences, Shiraz, Iran

Correspondence Address:
S Azemati
Department of Anesthesiology, Shiraz Medical Faculty, Shiraz University of Medical Sciences, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.30726

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How to cite this article:
Khosravi M B, Lahsaee M, Azemati S, Eghbal M H. Intraocular pressure changes after succinylcholine and endotracheal intubation: A comparison of thiopental and propofol on IOP. Indian J Ophthalmol 2007;55:164

How to cite this URL:
Khosravi M B, Lahsaee M, Azemati S, Eghbal M H. Intraocular pressure changes after succinylcholine and endotracheal intubation: A comparison of thiopental and propofol on IOP. Indian J Ophthalmol [serial online] 2007 [cited 2019 Aug 21];55:164. Available from: http://www.ijo.in/text.asp?2007/55/2/164/30726

Dear Editor,

In ophthalmological surgery related anesthesia, one of the most important problems is with patients who suffer from open globe injury and need emergency surgical intervention. Succinylcholine (Sch) is an old depolarizing muscle relaxant, which is commonly used to facilitate a rapid tracheal intubation in high-risk patients for aspiration. Laryngoscopy, endotracheal intubation[1] and Sch administration[2] can cause an increase in intraocular pressure (IOP). This study was undertaken to assess and compare the efficacy of thiopental and propofol (two common drugs which are used widely for induction of general anesthesia) in the prevention of increase in IOP following the administration of Sch and endotracheal intubation.

Following the ethics committee approval and written informed concent, 120 adult patients with American Society of Anesthesiologists class I-II, underwent elective non- ophthalmological surgery were enrolled in the study. The patients were randomly assigned to receive either thiopental 5 mg/kg (Group T) or propofol 2.5 mg/kg (Group P) for induction of general anesthesia. In both groups, succinylcholine 1.5 mg/kg was administered to facilitate the intubation. In all patients, mean arterial pressure, heart rate and IOP were recorded before pre-medication as baseline (T0), after pre-medication (T1), after induction of general anesthesia (T2), one minute after succinylcholine administration (T3), two (T4) and 5 (T5) minutes after intubation. IOP measurement was done by an applanation tonometer [Graph 1]. The IOP data were analyzed using t -test. Both thiopental and propofol caused a significant IOP reduction (12 2.8 mmHg in group T vs. 11.2 2.2 in group P, 20 and 26% decrease, respectively, compared to baseline value (15.3 3.1 in group T vs. 15.3 3.3 Group P).

One minute after Sch administration, a 40% increase in IOP in group T and a 6% decrease in group P were observed ( P <0.001). Endotracheal intubation did not cause any greater increase in IOP compared to Sch. administration.

In Zimmerman study,[3] where propofol and alfentanil were used, the peak increase of IOP occurred immediately after intubation.

In contrast, there are those who believe the more marked effect of Sch on IOP.[4] However, by reviewing the literature over a period of 45 years by Vachon et al .[5] the opinion against the use of Sch in open globe injuries has changed. In our study propofol prevented the increase of IOP caused by Sch and endotracheal intubation but raised when thiopental was used. We noted a more significant increase of IOP after Sch than endotracheal intubation when thiopental was used.

We can conclude that propofol prevents the rise of IOP, which is suspected to occur after succinylcholine administration and endotracheal intubation. So, it can be considered in patients whom the fear of increase of IOP is present and rapid sequence induction is mandatory.

 
  References Top

1.
Drenger B, Peer J. Attenuation of ocular and systemic responses to tracheal intubation by intravenous lignocaine. Br J Ophthalmol 1987;71:546-8.  Back to cited text no. 1
    
2.
Cook JH. The effect of suxamethonium on intraocular pressure. Anesthesia 1981;36:359-65.  Back to cited text no. 2
[PUBMED]    
3.
Zimmerman AA, Funk KJ, Tidwell JL. Propofol and alfentanil prevent the increase in intraocular pressure caused by succinylcholine and endotracheal intubation during a rapid sequence induction of anesthesia. Anesth Analg 1996;83:814-7.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Chiu CL, Lang CC, Wong PK, Delilkan AE, Wang CY. The effect of mivacurium pretreatment on intraocular pressure changes induced by suxamethonium. Anesthesia 1998;53:501-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.
Vachon CA, Warner DO, Bacon DR. Succinylcholine and the open globe. Tracing the teaching. Anesthesiology 2003;99:220-3.  Back to cited text no. 5
    


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