Intraocular pressure during rapid sequence induction: use of moderate-dose sufentanil or fentanyl and vecuronium or...

We studied the effect of rapid sequence induction of anaesthesia on intraocular pressure in physically fit, ASA class I or II patients using combinations of sufentanil (1 microgram/kg), or fentanyl (5 micrograms/kg) and vecuronium (0.2 mg/kg) or atracurium (1.0 mg/kg). All patients received thiopentone (5 mg/kg), following which those in group 1 received sufentanil and vecuronium, group 2 sufentanil and atracurium, group 3 fentanyl and vecuronium, and group 4 fentanyl and atracurium. Laryngoscopy and intubation were performed 60 seconds after induction. Intraocular pressure was measured prior to induction, 30 and 60 seconds after induction, immediately after intubation, and postintubation for 5 minutes. Postinduction and postintubation intraocular pressure values in all four groups did not exceed baseline values. We conclude that in fit patients, the combination of thiopentone, moderate dose narcotics, and an appropriate dose of vecuronium or atracurium produces satisfactory conditions for intubation following rapid sequence induction without increases in intraocular pressure. This technique should not, however, be employed when multiple other injuries are present, along with an open eye.