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BMC Anesthesiology

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Open Access 01-12-2023 | Esketamine | Research

Effect of intravenous induction with different doses of Esketamine combined with propofol and sufentanil on intraocular pressure among pediatric strabismus surgery: a randomized clinical trial

Authors: Jun Luo, Kuoqi Yin, Dinghuan Zhao, Zhao Zhang, Ruiqiang Sun

Published in: BMC Anesthesiology | Issue 1/2023

Abstract

Background

It is well-established that maintaining stable intraocular pressure (IOP) within the normal range during ophthalmic surgery is important. Esketamine is a commonly used drug in pediatric general anesthesia due to its good analgesic and sedative effects. However, its application in ophthalmic surgery is limited because it can increase IOP. The effect of esketamine combined with other common anesthetics on IOP has been underinvestigated. This study aimed to investigate the effect of different doses of esketamine combined with propofol and sufentanil on IOP during intravenous induction of general anesthesia for pediatric strabismus surgery.

Methods

A total of 181 children with strabismus undergoing unilateral eye surgery under general anesthesia were recruited. Intravenous induction included the use of sufentanil 0.1 µg/kg, propofol 3 mg/kg, and esketamine. Base on the dosage of esketamine, the patients were randomly allocated into three groups: esketamine low (EL) group with 0.25 mg/kg (n = 62), esketamine high (EH) group with 0.5 mg/kg (n = 60), and normal saline (NS) group (n = 59). Hemodynamic parameters, respiratory parameters, and IOP of the non-surgical eye were recorded and compared among the three groups at different time points: before induction (T₀), 1 min after induction but before laryngeal mask insertion (T₁), immediately after laryngeal mask insertion (T₂), and 2 min after laryngeal mask insertion (T₃).

Results

There were no significant differences in age, gender, body mass index (BMI), and respiratory parameters among the three groups at T₀. The IOP at T₁, T₂, and T₃ was lower than that at T₀ in all three groups. The EH group (12.6 ± 1.6 mmHg) had a significantly higher IOP than the EL group (12.0 ± 1.6 mmHg) and the NS group (11.6 ± 1.7 mmHg) at T₁. However, no difference was found between the EL and NS groups at any time point. Systolic blood pressure (SBP) and heart rate (HR) at T₁, T₂, and T₃ were lower than at baseline, and SBP and HR were higher at T₂ than at T₁. Additionally, the EH group had a significantly higher HR at T₁ than the other two groups. There was no significant difference in diastolic blood pressure (DBP) among the three groups at any time point.

Conclusion

Propofol combined with sufentanil significantly decreased IOP during the induction of general anesthesia. Although a dose of 0.5 mg/kg esketamine elevated IOP compared to the low-dose and control groups after induction, the IOP remained lower than baseline. 0.25 mg/kg esketamine combined with propofol and sufentanil had little effect on IOP. Therefore, we advocate that a maximum dose of 0.5 mg/kg esketamine combined with propofol and sufentanil will not elevate IOP compared to baseline in pediatric strabismus surgery.

Trial registration

The registration number is ChiCTR2200066586 at Chictr.org.cn. Registry on 09/12/2022.

Li X, Bai X, Liu Z, et al. The Effect of Inferior Rectus muscle thickening on intraocular pressure in Thyroid-Associated Ophthalmopathy. J Ophthalmol. 2021;2021:9736247. https://doi.org/10.1155/2021/9736247.CrossRefPubMedPubMedCentral

Yoo C, Chang MH, Song JS, Kim SH. Changes in intraocular pressure during strabismus surgery. Can J Ophthalmol. 2010;45(6):602–5. https://doi.org/10.3129/i10-049.CrossRefPubMed

Huang JY, Shih PC, Chen CT, et al. Effects of short-acting opioids on intraocular pressure during General Anesthesia: systematic review and network Meta-analysis. Pharmaceuticals (Basel). 2022;15(8):989. https://doi.org/10.3390/ph15080989.CrossRefPubMed

Wang J, Huang J, Yang S, et al. Pharmacokinetics and safety of esketamine in chinese patients undergoing painless gastroscopy in comparison with ketamine: a randomized, open-label clinical study. Drug Des Devel Ther. 2019;13:4135–44. https://doi.org/10.2147/DDDT.S224553.CrossRefPubMedPubMedCentral

Shoib S, Kotra M, Javed S, Nguyen VS, Malathesh BC. Esketamine-A quick-acting novel antidepressant without the disadvantages of ketamine. Horm Mol Biol Clin Investig. 2022;43(4):505–11. https://doi.org/10.1515/hmbci-2021-0099.CrossRefPubMed

Xu Y, Zheng Y, Tang T, Chen L, Zhang Y, Zhang Z. The effectiveness of esketamine and propofol versus dezocine and propofol sedation during gastroscopy: a randomized controlled study. J Clin Pharm Ther. 2022;47(9):1402–8. https://doi.org/10.1111/jcpt.13678.CrossRefPubMed

Zheng XS, Shen Y, Yang YY, et al. editors. ₅₀ and ED₉₅ of propofol combined with different doses of esketamine for children undergoing upper gastrointestinal endoscopy: A prospective dose-finding study using up-and-down sequential allocation method. J Clin Pharm Ther. 2022;47(7):1002–1009. doi:https://doi.org/10.1111/jcpt.13635.

Su M, Zhu Y, Liu S, et al. Median effective dose (ED₅₀) of esketamine combined with propofol for children to inhibit response of gastroscope insertion. BMC Anesthesiol. 2023;23(1):240. https://doi.org/10.1186/s12871-023-02204-y.CrossRefPubMedPubMedCentral

Ghaffari MS, Moghaddassi AP. Effects of ketamine-diazepam and ketamine- acepromazine combinations on intraocular pressure in rabbits. Vet Anaesth Analg. 2010;37(3):269–72. https://doi.org/10.1111/j.1467-2995.2010.00531.x.CrossRefPubMed

10.

Brusini P, Salvetat ML, Zeppieri M. How to measure intraocular pressure: an updated review of various Tonometers. J Clin Med. 2021;10(17):3860. https://doi.org/10.3390/jcm10173860.CrossRefPubMedPubMedCentral

11.

Mikhail M, Sabri K, Levin AV. Effect of anesthesia on intraocular pressure measurement in children. Surv Ophthalmol. 2017;62(5):648–58. https://doi.org/10.1016/j.survophthal.2017.04.003.CrossRefPubMed

12.

Yamada MH, Takazawa T, Iriuchijima N, Horiuchi T, Saito S. Changes in intraocular pressure during surgery in the lateral decubitus position under sevoflurane and propofol anesthesia. J Clin Monit Comput. 2016;30(6):869–74. https://doi.org/10.1007/s10877-015-9787-3.CrossRefPubMed

13.

Eti Z, Yayci A, Umuroglu T, Gögüş FY, Bozkurt N. The effect of propofol and alfentanil on the increase in intraocular pressure due to succinylcholine and intubation. Eur J Ophthalmol. 2000;10(2):105–9. https://doi.org/10.1177/112067210001000202.CrossRefPubMed

14.

Wadia S, Bhola R, Lorenz D, Padmanabhan P, Gross J, Stevenson M. Ketamine and intraocular pressure in children. Ann Emerg Med. 2014;64(4):385–388e1. https://doi.org/10.1016/j.annemergmed.2014.01.029.CrossRefPubMed

15.

Eberl S, Koers L, van Hooft J, et al. The effectiveness of a low-dose esketamine versus an alfentanil adjunct to propofol sedation during endoscopic retrograde cholangiopancreatography: a randomised controlled multicentre trial. Eur J Anaesthesiol. 2020;37(5):394–401. https://doi.org/10.1097/EJA.0000000000001134.CrossRefPubMed

16.

Zhan Y, Liang S, Yang Z, et al. Efficacy and safety of subanesthetic doses of esketamine combined with propofol in painless gastrointestinal endoscopy: a prospective, double-blind, randomized controlled trial. BMC Gastroenterol. 2022;22(1):391. https://doi.org/10.1186/s12876-022-02467-8.CrossRefPubMedPubMedCentral

17.

Xu C, Wei X, Zhang C, et al. Esketamine prevents propofol-induced injection pain: Randomized controlled trial. Front Pharmacol. 2022;13:991559. https://doi.org/10.3389/fphar.2022.991559.CrossRefPubMedPubMedCentral

18.

Ausinsch B, Rayburn RL, Munson ES, Levy NS. Ketamine and intraocular pressure in children. Anesth Analg. 1976;55(6):773–5. https://doi.org/10.1213/00000539-197611000-00005.CrossRefPubMed

19.

Baskan C, Baskan S. Does Practitioner Experience affect intraocular pressure after endotracheal intubation? Cureus. 2023;15(3):e36593. https://doi.org/10.7759/cureus.36593.CrossRefPubMedPubMedCentral

20.

Kim YS, Han NR, Seo KH. Changes of intraocular pressure and ocular perfusion pressure during controlled hypotension in patients undergoing arthroscopic shoulder surgery: a prospective, randomized, controlled study comparing propofol, and desflurane anesthesia. Med (Baltim). 2019;98(18):e15461. https://doi.org/10.1097/MD.0000000000015461.CrossRef

21.

Oberacher-Velten I, Zeman F, Lehmann F, et al. Preoperative therapy switch before glaucoma filtration surgery: influence of the systemic antiglaucomatous and local antiphlogistic therapy on the intraocular pressure. Ophthalmologe. 2017;114(7):632–8. https://doi.org/10.1007/s00347-016-0396-4.CrossRefPubMed

22.

Berthelsen LF. Ketamine: yay or neigh? Implications for cardiovascular regulation and considerations for field use. J Physiol. 2021;599(7):1949–50. https://doi.org/10.1113/JP281254.CrossRefPubMed

23.

Sobczak M, Asejczyk M, Geniusz M. Does body position, age, and heart rate induce IOP’s changes? Eur J Ophthalmol. 2022;32(3):1530–7. https://doi.org/10.1177/11206721211023313.CrossRefPubMed

24.

Del Sant LC, Sarin LM, Magalhães EJM, et al. Effects of subcutaneous esketamine on blood pressure and heart rate in treatment-resistant depression. J Psychopharmacol. 2020;34(10):1155–62. https://doi.org/10.1177/0269881120922955.CrossRefPubMed

25.

De Oliveira GS Jr, Kendall MC, Marcus RJ, McCarthy RJ. The relationship between the Bispectral Index (BIS) and the Observer alertness of Sedation Scale (OASS) scores during propofol sedation with and without ketamine: a randomized, double blinded, placebo controlled clinical trial. J Clin Monit Comput. 2016;30(4):495–501. https://doi.org/10.1007/s10877-015-9745-0.CrossRefPubMed

26.

Friedberg BL. BIS Monitoring transformed opioid-free propofol ketamine anesthesia from art to Science for Ambulatory Cosmetic surgery. Aesthetic Plast Surg. 2020;44(6):2308–11. https://doi.org/10.1007/s00266-020-01987-6.CrossRefPubMed

Title: Effect of intravenous induction with different doses of Esketamine combined with propofol and sufentanil on intraocular pressure among pediatric strabismus surgery: a randomized clinical trial
Authors: Jun Luo
Kuoqi Yin
Dinghuan Zhao
Zhao Zhang
Ruiqiang Sun
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Esketamine
Sufentanil
Strabismus
Strabismus
General Anesthesia
Published in: BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-023-02238-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of intravenous induction with different doses of Esketamine combined with propofol and sufentanil on intraocular pressure among pediatric strabismus surgery: a randomized clinical trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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