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© 2021 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Original Article
Changes in intraocular pressures associated with inhalational and mixed
anesthetic agents currently used in ophthalmic surgery
Sirisha Senthil, Mamata Nakka, Umashankar Rout1, Hasnat Ali2, Nikhil Choudhari, Swathi Badakere,
Chandrasekhar Garudadri
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Website:
www.ijo.in
DOI:
10.4103/ijo.IJO_2923_20
PMID:
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Purpose:
Methods:
Results: Mean
P0.001
P = 0.60 P = 0.33Conclusion:
Key words:
tonometer
1Department of Anesthesia, LV Prasad
2
12-Sep-2020
18-Jun-2021
[1]
measurement is essential for the appropriate management of
[2,3]
[4-9]
like the type of airway,[10-12] tonometer, and method of IOP
assessment,
Cite this article as: Senthil S, Nakka M, Rout U, Ali H, Choudhari N, Badakere S,
et al. Changes in intraocular pressures associated with inhalational and mixed
anesthetic agents currently used in ophthalmic surgery. Indian J Ophthalmol
2021;69:1808-14.
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July 2021 Senthil, et al 1809
Methods
time points and measured using two types of tonometers
Inclusion criteria
[20] Patients
Exclusion criteria
or kidney diseases, past history of vitreoretinal surgeries,
Procedures
µ
2
Statistical analysis
t test was
of P
Results
Demographic and clinical characters
n
type of airway management during anesthesia was either
and anesthesia parameters for all patients are shown in 1
during anesthesia are given in
Reductions in IOP after induction of anesthesia
2 and Fig
1810
T2 (P0.01 P 0.01
Eect of anesthetic regime on IOP
P = 0.78 for Perkins tonometer
measurements and P = 0.51
3, and Fig
T2 (P = 0.85 for Perkins tonometer measurements and P = 0.35
P = 0.42
for Perkins tonometer measurements and P = 0.20
Eect of endotracheal intubation and laryngeal mask airway
on IOP
P = 0.35 for T2 and P = 0.66
P = 0.13 for T2 and P = 0.24
Eect of age on IOP
Fig
patients (P = 0.42
Table 1: General, ocular, systemic, and anesthesia parameters in the study cohort (n=48)
Parameter Number of observations Mean Standard Deviation Minimum Maximum
Age 48 26.94 18.33 5 70
CCT 48 550.31 47.65 470 687
Number of AGM 48 1.06 1.63 0 4
Duration of surgery (minutes) 48 42.5 22.64 5 95
Perkin_T1 48 17.95 4.9 10 30
Perkin_T2 48 13.29 4 8 28
Perkin_T3 48 12.31 4.33 5 32
ICare PRO_T1 48 19.45 4.9 7.7 31.9
ICare PRO_T2 48 14.3 3.91 6.8 26.3
ICare PRO_T3 48 14.09 3.66 6.6 23.5
HR at_T1 48 87.93 16.37 57 126
HR at_T2 48 82.25 15.97 53 126
HR at_T3 44 80.09 17.06 52 116
BP_Systolic_T1 48 113.48 17.82 87 157
BP_Diastolc_T1 48 69.1 11.47 50 98
BP_Systolic_T2 48 107.98 11.87 88 139
BP_Diastolic_T2 48 65.56 9.22 44 90
BP_Systolic_T3 36 104.72 16.05 80 160
BP_Diastolic_T3 36 66.17 13.4 46 94
End tidal sevourane concentration in % 41 1.55 1.31 0.2 8
End tidal CO2 concentration in mm Hg 22 35.68 4.36 26 46
CCT: central corneal thickness, CO2: carbon dioxide, HR: heart rate, BP: blood pressure, AGM: antiglaucoma medications, T1: IOP measurement before
anesthesia, T2: IOP measurement after anesthesia and intubation, T3: IOP measurement at the conclusion of surgery, before extubating
Table 2: Differences in IOP measurements at various
time points in the study cohort. Multiple comparisons of
means using linear mixed‑effects models with Tukey’s
contrast; P values reported with Bonferroni’s correction
Mean
difference
Std.
error
95% CI P
LCL UCL
Perkins tonometer
T2 - T1 -4.66 0.58 -6.13 -3.18 0.00
T3 - T1 -5.64 0.58 -7.11 -4.16 <0.001**
T3 - T2 -0.98 0.58 -2.46 0.50 0.55
ICare PRO tonometer
T2 - T1 -5.16 0.56 -6.58 -3.74 <0.001**
T3 - T1 -5.36 0.56 -6.79 -3.94 <0.001**
T3 - T2 -0.20 0.56 -1.63 1.22 1.00
*Indicates P<0.05; **Indicates P<0.01. LCL: Lower condence limits;
UCL: Upper condence limits
July 2021 Senthil, et al 1811
P = 0.15
P0.02
when IOPs were measured using the Perkins tonometer [ 1
was used to measure IOPs [ 2
P = 0.26
P = 0.45
P0.01
Decreases in IOP values in glaucomatous and nonglauco-
matous eyes
eyes (n
P = 0.26
for T2 (P = 0.12
P0.03
P = 0.1
and P = 1.0
P = 1.0
Changes in heart rate and blood pressure
P0.03P0.003
P 0.01
P
P = 0.78 and P = 0
Figure 1: IOP measurements obtained using a Perkins tonometer. (a) Mean IOPs at different time points (T1, T2, and T3); (b) differences in
IOPs at the 3 time points in the sevourane and mixed anesthetics groups; (c) variations in IOPs noted at the 3 time points in adults and children
c
b
a
Figure 2: IOP measurements obtained using the ICare PRO tonometer. (a) Mean IOPs at different time points (T1, T2, and T3); (b) Differences in
IOPs at the 3 time points in the sevourane and mixed anesthetics groups; (c) variations in IOPs noted at the 3 time points in adults and children
c
b
a
1812
P0.01
2
Discussion
Similar to our results, Park et al[18] showed IOP
et al
et al [21]
[10,11]
Although our primary
Table 3: Differences in intraocular pressures (IOPs) in patients under general anesthesia using sevourane or mixed
anesthetic drugs between the baseline time point T1 (pre‑anesthesia) and time points T2 (after induction) and T3 (at the
conclusion of surgery) as measured with Perkins and ICare PRO tonometers. Test used: multiple comparison of means
using linear mixed‑effects models with Tukey’s contrast; P values reported with Bonferroni’s correction
Anesthetic Difference in
time points
Perkin tonometer ICare PRO tonometer
Mean
Difference
Std.
Error
95% CI PMean
Difference
Std.
Error
95% CI P
LCL UCL LCL UCL
Sevourane T2 - T1 -4.32 0.97 -6.60 -2.04 <0.01 -5.23 0.89 -7.31 -3.16 <0.01**
T3 - T1 -4.86 0.97 -7.14 -2.58 <0.01 -4.13 0.89 -6.21 -2.06 <0.01**
T3 - T2 -0.55 0.97 -2.82 1.73 1.00 1.10 0.89 -0.98 3.18 0.64
Mixed
anesthetics
T2 - T1 -4.94 0.74 -6.67 -3.21 <0.01 -5.10 0.72 -6.79 -3.40 <0.01**
T3 - T1 -6.29 0.74 -8.02 -4.56 <0.01 -6.40 0.72 -8.10 -4.71 <0.01**
T3 - T2 -1.35 0.74 -3.07 0.38 0.20 -1.31 0.72 -3.00 0.38 0.21
*Indicates P<0.05; **Indicates P<0.01
July 2021 Senthil, et al 1813
more for patients on whom laryngeal mask airways were used
et al[19]
P
[28]
[29-31] It is known that the IOP
[29,30] All the
IOP measurements in our study were measured in supine
2 level is another important parameter
[32,33] Levels of
2
2
[21] In our study, the mean
2 levels and end-tidal
The Perkins tonometer is a handheld variant of the
[34]
shown good agreement with Perkins tonometer estimations
of IOP, although slightly overestimates when IOP values are
[15]
in patients under GA, than any other previous work on this
The main limitation of this study is the involvement of multiple
anesthetists and ophthalmologists (two ophthalmologists were
Conclusion
pre-anesthesia IOP measurements with IOP measurements
Financial support and sponsorship
Conicts of interest
References
1814
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