Succinylcholine and the Open Globe: Questions Unanswered

Chidiac, Elie Joseph

doi:10.1097/00000542-200404000-00045

Cited by 16 publications

(25 citation statements)

References 8 publications

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“…Volatile agents like halothane, isoflurane and sevoflurane have been shown to decrease IOP, as has the intravenous anaesthetic agent propofol [2][3][4]. Other drugs, such as suxamethonium, can produce an increase in IOP [5]. Several human and animal studies have peripherally investigated the effect of N 2 O on IOP, but all have used N 2 O in combination with anaesthetic agents that are known to affect IOP [6][7][8].…”

mentioning

confidence: 99%

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

Lalwani¹,

Fox²,

et al. 2012

Anaesthesia

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SummaryMany anaesthetic agents affect intra-ocular pressure, yet little is known about nitrous oxide and intra-ocular pressure. This study assessed the effect of nitrous oxide on intra-ocular pressure in 20 healthy adult volunteers. The intra-ocular pressure was measured at baseline, while breathing a 70:30 mix of nitrous oxide and oxygen for 12 min, and then while breathing room air for 15 min. A linear mixed effects model was used to assess change in intra-ocular pressure over time. There was no significant difference in intra-ocular pressure between baseline and during or after nitrous oxide inhalation. Several differences in intra-ocular pressure were noted between internal time-points: pressure increased by 2.4 mmHg between 3 and 6 min of breathing nitrous oxide (p = 0.01); it increased by 1.4 mmHg between 3 and 9 min of breathing nitrous oxide (p = 0.046); and it decreased by 2.2 mmHg between 6 min of breathing nitrous oxide and 15 min of breathing room air (p = 0.035). This study indicates that nitrous oxide inhalation does not significantly change intra-ocular pressure from baseline values in a population of healthy adults. Accepted: 25 October 2011There have been few studies to assess the effect of nitrous oxide (N 2 O) on intra-ocular pressure (IOP) [1]. This is an important question, as many anaesthetic agents produce clinically significant changes in IOP. Volatile agents like halothane, isoflurane and sevoflurane have been shown to decrease IOP, as has the intravenous anaesthetic agent propofol [2][3][4]. Other drugs, such as suxamethonium, can produce an increase in IOP [5]. Several human and animal studies have peripherally investigated the effect of N 2 O on IOP, but all have used N 2 O in combination with anaesthetic agents that are known to affect IOP [6][7][8]. One report indicates that N 2 O seems to have no effect on IOP, but supporting data or references are not given [9]. To our knowledge, there are no other studies that have explored the effect of isolated N 2 O administration on IOP in humans.Reliable IOP measurements are essential for the effective management of glaucoma, yet accurate values are

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confidence: 99%

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

Lalwani¹,

Fox²,

et al. 2012

Anaesthesia

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“…Despite this debate about the use of succinylcholine in open globe injury, most authors still agree on its use in difficult airway cases with salvageable eye situations. [20] Limitations of the study A limitation of this study is that the effect of dexmedetomidinc on the IOP changes after succinylcholine and intubation cannot be isolated from its action on the haemodynamics since both effects are parallel and a causal relationship cannot be denied. However, this limitation should not decline the potential advantage of using dexmedetomidiue as alternative agent to obtund the IOP changes of succinylcholine and intubation.…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine: A Novel Premedicant in RSI - A Clinical Study Conducted in a Tertiary Care Institution in South India

Beula¹

2017

jmscr

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“…In addition, midazolam reduces intraocular pressure [11]. Deep anaesthesia by itself, mitigates the hypertensive response to intubation and rises in IOP [12]. In this patient, there was a modest rise in blood pressure after intubation from the baseline value of 110/70 mmHg to 128/85 mmHg after intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Chidiac [12] reported a retrospective study at their institution, where suxamethonium was used in 8 cases of open eye surgery. There were no reports of vitreous loss, no lens or uvea extrusion, and no excessive intraocular bleeding.…”

Section: Discussionmentioning

confidence: 99%

Vitreous Humour Extrusion after Suxamethonium Induction of Anaesthesia in a Polytraumatized Patient: A Case Report

Amadasun

Isesele

2010

Case Reports in Medicine

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Introduction. Suxamethonium, a deepolarizing muscle relaxant, increases intraocular pressure. It is therefore advised to be avoided in open globe surgery, for fear of extruding ocular contents. Several anecdotal reports support this fear. Some workers however, dispute this claim. There is as yet no formal case report in the literature on the subject. Case Presentation. A 34-year old Nigerian male, was involved in a road traffic accident. He presented at the Accident & Emergency Unit of our hospital about 2 hours after the accident. Clinical examination revealed right corneal laceration (with intact ocular contents) and intra-abdominal visceral injury. Emergency laparotomy was scheduled, to be followed with corneal repair. Anaesthesia was induced with 10 mg midazolam, 100 mg ketamine, and 100 mg suxamethonium given intravenously in sequence. After laparotomy, the ophthalmologists reported for the corneal repair, only to find that the vitreous humour has been extruded. Conclusion. The fear about the use of suxamethonium in open globe situations is real. It will be good clinical judgment to use alternative drugs and techniques to effect rapid muscle relaxation, in the anaesthetic management of the open globe patient. This would be of interest to anaesthetists, ophthalmologists and clinical pharmacologists among others.

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Succinylcholine and the Open Globe: Questions Unanswered

Cited by 16 publications

References 8 publications

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

The effect of nitrous oxide on intra‐ocular pressure in healthy adults*

Dexmedetomidine: A Novel Premedicant in RSI - A Clinical Study Conducted in a Tertiary Care Institution in South India

Vitreous Humour Extrusion after Suxamethonium Induction of Anaesthesia in a Polytraumatized Patient: A Case Report

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