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Intraocular pressures after ketamine and sevoflurane in children with glaucoma undergoing examination under

L Jones1, V Sung, G Lascaratos

  • 1Birmingham and Midland Eye Centre, City Hospital, Dudley Road, Birmingham B18 7QH, UK.

The British Journal of Ophthalmology
|August 21, 2009
PubMed

Insights

Sevoflurane significantly lowers intraocular pressure (IOP) compared to ketamine during examination under anesthesia (EUA) in children. Ketamine may be preferred for accurate IOP measurements in pediatric glaucoma evaluations.

Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Pediatric Medicine

Background:

  • Accurate intraocular pressure (IOP) measurement is crucial for diagnosing and managing pediatric glaucoma.
  • Examination under anesthesia (EUA) is often necessary for reliable IOP assessment in young children.
  • Common anesthetic agents can influence IOP readings, potentially affecting diagnostic accuracy.

Purpose of the Study:

  • To compare the effect of ketamine and sevoflurane anesthesia on intraocular pressure (IOP) in children undergoing examination under anesthesia (EUA).
  • To determine which anesthetic agent, ketamine or sevoflurane, provides a more accurate IOP measurement in pediatric patients requiring EUA for glaucoma assessment.

Main Methods:

  • A study involving consecutive pediatric patients with suspected or confirmed glaucoma requiring EUA for IOP measurement.
  • Intraocular pressure (IOP) was measured using a Perkins applanation tonometer after induction with ketamine (intramuscular or intravenous) and subsequently after maintenance with sevoflurane.
  • Paired t-tests and one-way ANOVA were used to analyze differences in IOP between the two anesthetic agents and across different IOP subgroups.

Main Results:

  • The mean IOP measured after sevoflurane anesthesia (17 mmHg) was significantly lower than that measured after ketamine anesthesia (24.4 mmHg) (p<0.001).
  • The percentage difference in IOP between sevoflurane and ketamine was 28.5%.
  • This significant IOP reduction with sevoflurane was observed irrespective of the baseline IOP level, with no statistically significant difference between subgroups.

Conclusions:

  • Sevoflurane demonstrates a significant IOP-lowering effect compared to ketamine during EUA in children.
  • The choice of anesthetic agent can impact IOP measurements, with sevoflurane causing a notable decrease.
  • Ketamine may be a more suitable induction agent when precise IOP measurement is critical in pediatric EUA for glaucoma management.
Abstract

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