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Effect of general inhalational anesthesia on intraocular pressure measurements in normal and glaucomatous children

Engy Samy1, Yasmine El Sayed1, Ahmed Awadein2

  • 1Faculty of Medicine, Cairo University, 16 Abd El-Hady Street, Manial, Cairo, 11451, Egypt.

International Ophthalmology
|March 24, 2021
PubMed

Insights

Intraocular pressure (IOP) measurements in children vary significantly under sevoflurane anesthesia. Caution is advised when interpreting IOP readings during anesthesia, especially in pediatric glaucoma patients.

Area of Science:

  • Ophthalmology
  • Anesthesiology
  • Pediatrics

Background:

  • Accurate intraocular pressure (IOP) measurement is crucial for diagnosing and managing pediatric glaucoma.
  • General inhalational anesthesia is often required for ophthalmic procedures in children, but its effect on IOP is not fully understood.
  • Sevoflurane is a common anesthetic agent used in pediatric patients.

Purpose of the Study:

  • To assess the agreement between IOP measurements in awake children and during various stages of sevoflurane inhalational anesthesia.
  • To compare these agreements in children with glaucoma and healthy controls.

Main Methods:

  • Prospective study involving 43 glaucomatous children and 30 healthy controls.
  • IOP measured using Perkins tonometer before anesthesia, and during light, intermediate, and deep anesthesia, and after intubation.
  • Anesthesia depth monitored using bispectral index; IOP agreement analyzed with Bland-Altman plots.

Main Results:

  • Mean IOP was significantly lower at all anesthetic stages in both groups.
  • High variability (coefficient of variation >20%) observed in IOP measurements under anesthesia.
  • Wide limits of agreement (>7 mmHg in controls, >20 mmHg in glaucoma group) indicate poor IOP measurement consistency during anesthesia.

Conclusions:

  • Inhalational anesthesia with sevoflurane causes variable effects on IOP measurements in children at all stages.
  • Significant discrepancies exist between awake and anesthetized IOP readings, particularly in glaucomatous children.
  • Clinical decisions based on IOP measurements obtained during anesthesia require extreme caution.
Abstract

Keywords:
General anesthesiaGlaucomaIOPInhalationPediatricSevoflurane

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