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Intraocular pressure and hemodynamic changes following tracheal intubation in children
M F Watcha1, F C Chu, J L Stevens
1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO.
Insights
For optimal intraocular pressure (IOP) measurement in children post-tracheal intubation, wait until heart rate (HR) and mean arterial pressure (MAP) stabilize. This ensures IOP readings reflect pre-anesthesia levels, avoiding misleading results under anesthesia.
Area of Science:
- Pediatric Anesthesiology
- Ophthalmology
- Critical Care Medicine
Background:
- Intraocular pressure (IOP) monitoring is crucial in pediatric anesthesia.
- Tracheal intubation can transiently alter IOP, heart rate (HR), and mean arterial pressure (MAP).
- Determining the optimal timing for IOP measurement post-intubation is essential for accurate clinical assessment.
Purpose of the Study:
- To identify the optimal time for measuring intraocular pressure (IOP) in pediatric patients after tracheal intubation.
- To assess the relationship between IOP, heart rate (HR), and mean arterial pressure (MAP) during halothane and nitrous oxide anesthesia.
Main Methods:
- Randomized controlled trial conducted in a tertiary-care children's hospital.
- Thirteen healthy children undergoing elective strabismus surgery were included.
- Patients received either 0.5% or 1.0% end-tidal halothane in 66% nitrous oxide, with IOP, HR, and MAP measured pre- and post-intubation.
Main Results:
- Changes in heart rate (HR) and mean arterial pressure (MAP) were significant predictors of intraocular pressure (IOP) fluctuations.
- IOP returned to baseline (preintubation) levels as HR and MAP normalized.
- Intraocular pressure measurements obtained under anesthesia may not accurately represent awake IOP values.
Conclusions:
- Intraocular pressure (IOP) should be measured in pediatric patients only after heart rate (HR) and mean arterial pressure (MAP) have returned to their preintubation levels.
- This recommendation applies specifically to children undergoing anesthesia with halothane and nitrous oxide.
- Accurate IOP assessment in pediatric patients requires careful consideration of hemodynamic stability post-intubation.
Study Objective:
To determine the optimal time in which to make intraocular pressure (IOP) measurements in children following tracheal intubation.
Design:
Randomized, controlled trial.
Setting:
Operating rooms of a tertiary-care children's hospital.
Patients:
Thirteen healthy children undergoing elective strabismus correction surgery under halothane and nitrous oxide (N2O) endotracheal anesthesia.
Interventions:
Following induction of anesthesia, patients were randomly assigned to receive stable end-tidal halothane concentrations of 0.5% or 1.0% in 66% N2O.
Measurements And Main Results:
Baseline (preintubation) IOP, heart rate (HR), and mean arterial pressure (MAP) were recorded after 10 minutes of steady-state end-tidal concentrations. These measurements were repeated at 1-minute intervals following tracheal intubation, which was facilitated with atracurium. HR and MAP changes were found to be good predictors of IOP changes. IOP returned to baseline (preintubation) values when HR and MAP returned to preintubation levels. However, IOP measurements under anesthesia may not reflect awake values.
Conclusions:
We recommend that IOP be measured only after HR and MAP have returned to preintubation levels in children who have undergone tracheal intubation during halothane and N2O anesthesia.