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Oatts JT, Shen S, Zhu H, Gong Q, Yu Y, Ying GS, Han Y, Liu H. A Prospective Study of the Effects of General Anesthesia on Intraocular Pressure in Healthy Children. OPHTHALMOLOGY SCIENCE 2024; 4:100455. [PMID: 38313401 PMCID: PMC10837640 DOI: 10.1016/j.xops.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 02/06/2024]
Abstract
Purpose To determine the effect of general anesthesia on intraocular pressure (IOP) in children with no intraocular pathology and determine which postanesthetic time point is most predictive of preinduction IOP. Design Prospective observational study. Participants Children with no intraocular pathology ≤ 18 years scheduled for general anesthesia as part of their routine care followed by a pediatric ophthalmologist at Nanjing Medical University. Methods Participants underwent a standardized general anesthetic protocol using a mask induction with sevoflurane and propofol maintenance. Intraocular pressure was measured at the following 7 time points: preinduction (taken in the preoperative area), postinduction minutes 1, 3, and 5, and postairway placement minutes 1, 3, and 5 for a total time period of 10 minutes after induction. A generalized estimating equation was used to evaluate the effect of anesthesia on IOP and the effect of patient factors (age, gender, vital signs, and airway type) on preanesthetic and postanesthetic IOP. An IOP prediction model was developed using the postanesthesia IOP measurements for predicting preinduction IOP. Main Outcome Measures Intraocular pressure and change in IOP at prespecified time points. Results Eighty-five children were enrolled with a mean ± standard deviation (SD) age of 7.5 ± 2.9 years. Mean ± SD preinduction IOP was 20.1 ± 3.7 mmHg. Overall, IOP was lowest at 3 minutes postinduction, decreased to a mean of 13.4 ± 3.7 mmHg (P < 0.001). After this, IOP rose 5 minutes postinduction to 16.5 ± 4.2 mmHg, which did not reach preinduction IOP levels (P < 0.001). The IOP prediction model showed that combining 1 minute postinduction and 3 minutes postairway was most predictive (R2 = 0.13), whereas 1 minute postairway was least predictive of preinduction IOP (R2 = 0.01). Conclusions After the induction of general anesthesia in children, IOP temporarily decreases with a trough at 3 minutes postinduction before increasing and remaining stable just below preinduction levels. Intraocular pressure measurements taken 1 minute after induction with 3 minutes after airway placement are most predictive of preinduction IOP, though predictive value is relatively low. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Julius T. Oatts
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Shiya Shen
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hui Zhu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Qi Gong
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yinxi Yu
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gui-shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Hu Liu
- Department of Ophthalmology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Luo J, Yin K, Zhao D, Zhang Z, Sun R. 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. BMC Anesthesiol 2023; 23:275. [PMID: 37582704 PMCID: PMC10426143 DOI: 10.1186/s12871-023-02238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023] Open
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.
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Affiliation(s)
- Jun Luo
- Department of Anesthesiology, Tianjin Eye Hospital, 4 Gansu Road, 300020, Tianjin, China
| | - Kuoqi Yin
- Department of Anesthesiology, Tianjin Eye Hospital, 4 Gansu Road, 300020, Tianjin, China
| | - Dinghuan Zhao
- Department of Anesthesiology, Tianjin Eye Hospital, 4 Gansu Road, 300020, Tianjin, China
| | - Zhao Zhang
- Department of Anesthesiology, Tianjin Eye Hospital, 4 Gansu Road, 300020, Tianjin, China
| | - Ruiqiang Sun
- Department of Anesthesiology, Tianjin Eye Hospital, 4 Gansu Road, 300020, Tianjin, China.
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Torres Soblechero L, Ocampo Benegas DE, Manrique Martín G, Butragueño Laiseca L, Leal Barceló AM, Parreño Marchante A, López-Herce Cid J, Mencía Bartolome S. Prospective observational study on the use of continuous intravenous ketamine and propofol infusion for prolonged sedation in critical care. An Pediatr (Barc) 2023; 98:276-282. [PMID: 36925340 DOI: 10.1016/j.anpede.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 03/15/2023] Open
Abstract
INTRODUCTION Analgesia and sedation are a priority in paediatric intensive care. The combination of ketamine and propofol is a possible option in patients requiring prolonged or difficult sedation and to reduce the use of benzodiazepines and opiates. The aim of this study was to assess the efficacy and safety of combination ketamine and propofol in continuous infusion for prolonged analgesia/sedation in the paediatric intensive care setting. PATIENTS AND METHODS Prospective, observational single-group cohort study in patients aged 1 month to 16 years admitted to the paediatric intensive care unit in 2016-2018 that received ketamine and propofol in continuous infusion for analgesia and sedation. We collected data on demographic and clinical characteristics, analgesia and sedation scores (MAPS, COMFORT-B and SOPHIA), haemodynamic parameters and adverse events. RESULTS The study included 32 patients. The maximum dose of ketamine was 1.5 mg/kg/h (interquartile range [IQR], 1-2 mg/kg/h) and the infusion duration was 5 days (IQR, 3-5 days). The maximum dose of propofol was 3.2 mg/kg/h (IQR, 2.5-3.6 mg/kg/h) and the infusion duration, 5 days (IQR, 3-5 days). Thirty (93.7%) patients had previously received midazolam and 29 (90.6%) fentanyl. Analgesia scores did not change after initiation of the ketamine and propofol infusion. There was a statistically significant increase in the COMFORT-B score, but the score remained in the adequate sedation range (12-17). There were small but statistically significant decreases in the mean arterial pressure (from 64 mmHg to 60 mmHg; P = .006) and the diastolic blood pressure (from 50.5 to 48 mmHg; P = .023) 1 h after the initiation of the ketamine and propofol infusion, but this difference was not observed 12 h later and did not require administration of vasoactive drugs. No other major adverse events were detected during the infusion. CONCLUSIONS The combination of ketamine and propofol in continuous infusion is a safe treatment in critically ill children that makes it possible to achieve an appropriate level of analgesia and sedation without relevant haemodynamic repercussions.
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Affiliation(s)
- Laura Torres Soblechero
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Doris Elena Ocampo Benegas
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Manrique Martín
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Laura Butragueño Laiseca
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Andrea María Leal Barceló
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jesús López-Herce Cid
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Mencía Bartolome
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Beach KM, Hung LF, Lou L, Ostrin LA. Diurnal Variation and Effects of Dilation and Sedation on Intraocular Pressure in Infant Rhesus Monkeys. Curr Eye Res 2023; 48:289-296. [PMID: 36357337 PMCID: PMC10006333 DOI: 10.1080/02713683.2022.2141782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Intraocular pressure (IOP) is an important factor in numerous ocular conditions and research areas, including eye growth and myopia. In infant monkeys, IOP is typically measured under anesthesia. This study aimed to establish a method for awake IOP measurement in infant rhesus monkeys, determine diurnal variation, and assess the effects of dilation and sedation. METHODS Awake IOP (iCare TonoVet) was measured every 2 h from 7:30 am to 5:30 pm to assess potential diurnal variations in infant rhesus monkeys (age 3 weeks, n = 11). The following day, and every 2 weeks to age 15 weeks, IOP was measured under three conditions: (1) awake, (2) awake and dilated (tropicamide 0.5%), and (3) sedated (ketamine and acepromazine) and dilated. Intraclass correlation coefficient (ICC) was used to determine intersession repeatability, and repeated measures. ANOVA was used to determine effects of age and condition. RESULTS At age 3 weeks, mean (±SEM) awake IOP was 15.4 ± 0.6 and 15.2 ± 0.7 mmHg for right and left eyes, respectively (p=.59). The ICC between sessions was 0.63[-0.5 to 0.9], with a mean difference of 2.2 ± 0.3 mmHg. Diurnal IOP from 7:30 am to 5:30 pm showed no significant variation (p=.65). From 3 to 15 weeks of age, there was a significant effect of age (p=.01) and condition (p<.001). Across ages, IOP was 17.8 ± 0.7 mmHg while awake and undilated, 18.4 ± 0.2 mmHg awake and dilated, and 11.0 ± 0.3 mmHg after sedation and dilation. CONCLUSIONS Awake IOP measurement was feasible in young rhesus monkeys. No significant diurnal variations in IOP were observed between 7:30 am and 5:30 pm at age 3 weeks. In awake monkeys, IOP was slightly higher after mydriasis and considerably lower after sedation. Findings show that IOP under ketamine/acepromazine anesthesia is significantly different than awake IOP in young rhesus monkeys.
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Affiliation(s)
- Krista M Beach
- University of Houston College of Optometry, Houston, TX, United States
| | - Li-Fang Hung
- University of Houston College of Optometry, Houston, TX, United States
| | - Linjiang Lou
- University of Houston College of Optometry, Houston, TX, United States
| | - Lisa A Ostrin
- University of Houston College of Optometry, Houston, TX, United States
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Torres Soblechero L, Ocampo Benegas DE, Manrique Martín G, Butragueño Laiseca L, Leal Barceló AM, Parreño Marchante A, López-Herce Cid J, Mencía Bartolome S. Uso concomitante de ketamina y propofol en perfusión continua en cuidados intensivos: eficacia y seguridad para analgesia y sedación prolongada. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Kear B, Gold CR, Bhola R. Bilateral Acute Angle-Closure Glaucoma: A Case Report of an Unusual Cause of Acute Headache in a Child. Clin Pract Cases Emerg Med 2021; 5:443-446. [PMID: 34813440 PMCID: PMC8610455 DOI: 10.5811/cpcem.2021.7.52671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/26/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Acute angle-closure glaucoma (AACG) is typically considered a disease of adulthood. However, AACG may occasionally be seen in children. The clinical presentation is similar to adults, including headache, vomiting, and eye pain. However, the etiology of angle closure in children is different and most often associated with congenital anterior segment abnormalities. A precipitating factor of AACG in children with previous established, anterior segment abnormalities is eye dilation, which may occur during routine ophthalmological examination with topical mydriasis, or physiologic mydriasis upon entering a dark room. Case Report We describe a 5-year-old child with a history of severe prematurity and retinopathy of prematurity (ROP) presenting with bilateral AACG following a routine outpatient, dilated ophthalmological examination. While angle-closure glaucoma has previously been reported in cases of ROP, a bilateral acute attack of AACG following pupil dilation in regressed ROP has hitherto been unreported. Conclusion Given the association of ROP and AACG, it can be expected that as the survival rate of premature infants improves, the incidence of ROP and AACG may also increase. It is therefore prudent for the emergency physician to have AACG on the differential for pediatric patients with headache and eye pain.
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Affiliation(s)
- Breelan Kear
- Providence St. Joseph Hospital Orange, Department of Emergency Medicine, Orange, California
| | - Claudia R Gold
- CHOC Children's Hospital, Department of Pediatric Emergency Medicine, Orange, California
| | - Rahul Bhola
- CHOC Children's Hospital, Department of Pediatric Emergency Medicine, Orange, California
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Jamal D, Powell C. Paediatric procedural sedation in the emergency department: is ketamine safe? Arch Dis Child Educ Pract Ed 2021; 106:120-124. [PMID: 32522748 DOI: 10.1136/archdischild-2019-318610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/31/2020] [Accepted: 05/12/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Dried Jamal
- Pediatric Emergency, Sidra Medical and Research Center, Doha, Qatar
| | - Colin Powell
- Emergency Medicine, Sidra Medical and Research Center, Doha, Qatar .,Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
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Fisher AD, DesRosiers TT, Drew BG. Prehospital Analgesia and Sedation: a Perspective from the Battlefield. CURRENT TRAUMA REPORTS 2020. [DOI: 10.1007/s40719-020-00199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Effect of general anaesthesia on intraocular pressure in paediatric patients: a systematic review. Eye (Lond) 2020; 35:1205-1212. [PMID: 32690926 DOI: 10.1038/s41433-020-1093-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/26/2020] [Accepted: 07/08/2020] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Assessment of the impact of general anaesthetic agents on intraocular pressure (IOP) in children via systematic review. METHODS Pubmed, Embase, and CENTRAL databases were systematically searched to identify randomised controlled trials, prospective, and interventional studies. The search included all studies through October 5, 2018 with no date or language restrictions. A linear mixed-effects regression analysis was performed to study the change in IOP after general anaesthesia (GA). RESULTS The strategy identified 518 studies that met search criteria. Six studies (531 eyes) were included for quantitative synthesis. Seven categories of mixed and non-mixed induction and maintenance agents were compared. When assessing all agents utilising a model of mean IOP as a function of time, IOP decreased after induction phase at a rate of -0.59 ± 0.19 mmHg/min (P value = 0.006). CONCLUSIONS This systematic review showed that most anaesthetic agents significantly decrease IOP over time after the induction phase of general anaesthesia in children. An understanding of the effects of GA on IOP is critical for those performing paediatric ophthalmic examinations under anaesthesia.
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Sigmund AB, Cushing AC, Hendrix DVH. Ophthalmic findings in 10 captive, anesthetized chimpanzees (Pan troglodytes). Vet Ophthalmol 2020; 23:760-763. [PMID: 32374078 DOI: 10.1111/vop.12766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To document ophthalmic findings, Schirmer's tear test I (STT), and intraocular pressure (IOP) values for anesthetized chimpanzees (Pan troglodytes). ANIMALS STUDIED Ten captive chimpanzees from Zoo Knoxville and Chattanooga Zoo. PROCEDURES Ten chimpanzees were anesthetized for annual physical examinations, blood collection, and ophthalmic examination. Each was anesthetized with intramuscular (IM) injections of dexmedetomidine, midazolam, and ketamine. Ophthalmic findings and STT and IOP values in addition to general health information were recorded for each chimpanzee. Pupillary diameter was measured after topical tropicamide administration. A Shapiro-Wilk test of normality was done for age, weight, STT values, IOP values, and pupil size. RESULTS Ages ranged from 11 to 42 years. Weight range was 40.9-83.6 kg. The mean STT was 13.4 ± 5.3 mm/min. The mean IOP was 14 ± 4.2 mm Hg. Seven of the 10 chimpanzees were considered geriatric, and each had perilimbal lipid deposits. Sedative-associated miosis was successfully counteracted with a regimen of repeated applications of tropicamide, enabling complete fundic examination. CONCLUSIONS A complete ophthalmic examination can be done on anesthetized chimpanzees with the protocol used in this study.
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Affiliation(s)
- Alex B Sigmund
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Andrew C Cushing
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
| | - Diane V H Hendrix
- Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN, USA
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Sethi S, Subhedar K, Sharma S, Sethi M. Acceptability and feasibility of an innovative anesthesia technique in a low-resource setting at a rural community ophthalmic center: A prospective journey. Anesth Essays Res 2020; 14:203-207. [PMID: 33487816 PMCID: PMC7819419 DOI: 10.4103/aer.aer_46_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Ocular blindness and ocular morbidities are very much prevalent in pediatric age group in India. Mostly, these are all surgically amenable, provided they have access to safe anesthesia. Suboptimal facilities for conventional general anesthesia (GA) led to a different thought process. The combination of anesthetic and analgesic property of ketamine was utilized in a low-resource setting at a tertiary ophthalmic center for pediatric ophthalmic surgeries. Aims: The aim of this study was to decipher whether this technique is acceptable and feasible. Settings and Design: It was a prospective consecutive series at a rural eye center done over a period of 5 years. Materials and Methods: Inclusion criterion was children undergoing eye surgeries between the ages of 7 and 18 years, who could be adequately counseled about the concept of painless intravenous cannulation and subsequent painless block. Intravenous anesthesia comprised of ketamine, in conjunction with peribulbar block. Complications of the technique, time to discharge, mean pain score, and patient and surgeon satisfaction score were documented. Statistical Analysis Used: Data were analyzed on Microsoft Excel. Results: A total of 905 cases were conducted uneventfully without conversion to GA. No emergency resuscitation was required. The surgeon and the patient had a satisfying experience, with the technique being totally acceptable to them. Conclusions: Intravenous ketamine is an inexpensive and safe anesthetic technique when used in conjunction with regional block and is certainly a boon for minimal resource ophthalmic setup in rural India.
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Anesthesia for Ophthalmological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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van der Walt JG, Roodt F, Tinley C. How does sevoflurane induction, followed by a ketamine maintenance infusion, affect intraocular pressure? Establishment of an anaesthetic protocol for paediatric glaucoma examinations under anaesthesia. Br J Ophthalmol 2017; 102:902-905. [PMID: 29051328 DOI: 10.1136/bjophthalmol-2017-310872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/25/2017] [Accepted: 09/30/2017] [Indexed: 11/03/2022]
Abstract
Accurate measurement of intraocular pressure (IOP) is essential in paediatric glaucoma management. Children require serial measurements and examination under anaesthesia (EUA). Most anaesthetic agents reduce IOP, and the ideal time to measure IOP under anaesthesia is questionable. STUDY PURPOSE To determine the effect of sevoflurane induction, followed by intravenous ketamine infusion on IOP, in children undergoing EUA for glaucoma or suspected glaucoma, and to establish the earliest time point at which reliable, repeatable IOP measurements can be obtained under anaesthesia. METHOD A prospective, descriptive study of IOP changes occurring in children requiring EUAs. A standardised anaesthetic protocol: sevoflurane induction, intravenous cannulation, 2 mg/kg intravenous ketamine bolus and 4 mg/kg/hour maintenance for 15 min. IOP measurements (taken supine with a Perkins applanation tonometer) and physiological variables were recorded. RESULTS IOPs were measured in 25 children (50 eyes). Twenty-six eyes (52%) were glaucomatous. Mean patient age was 29 months (2-88 months). Physiological variables returned to baseline at 8 min, correlating with recorded sevoflurane elimination. Mean IOP after sevoflurane induction was 3.68 mm Hg lower than with ketamine maintenance at 15 min (95% CI 1.35 to 6.02 mm Hg) (p=0.002). Contrastingly, the difference in IOP between ketamine anaesthesia at 15 min and near wakefulness was 0.28 mm Hg (95% CI -2.23 to 2.79 mm Hg) (p=0.826). CONCLUSION Sevoflurane's IOP-lowering effect is reversed 15 min after the discontinuation of the inhalational gas, if anaesthesia is maintained with an intravenous ketamine infusion. IOP measurements appear to stabilise at this time point until the point of near wakefulness and may reflect awake values.
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Affiliation(s)
- Jessica Gwendoline van der Walt
- Department of Anaesthesia, University of Cape Town, Cape Town, South Africa.,Department of Anaesthesia, Victoria Hospital, Cape Town, South Africa
| | - Francois Roodt
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.,Department of Anaesthesia, Groote Schuur Hospital, Cape Town, South Africa.,Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Christopher Tinley
- Red Cross War Memorial Children's Hospital, Cape Town, South Africa.,Department of Ophthalmology, University of Cape Town, Cape Town, Western Cape, South Africa
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A Novel Agent for Management of Agitated Delirium: A Case Series of Ketamine Utilization in the Pediatric Emergency Department. Pediatr Emerg Care 2017; 33:e58-e62. [PMID: 26466151 DOI: 10.1097/pec.0000000000000578] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Control of the agitated patient in the emergency department is challenging. Many options exist for chemical sedation, but most have suboptimal pharmacodynamic action, and many have undesirable adverse effects. There are reports of ketamine administration for control of agitation prehospital and in traumatically injured patients. Ketamine is a noncompetitive N-methyl-D-aspartic acid receptor antagonist, making it an effective dissociative agent. We present 5 cases of ketamine administration to manage agitated adolescent patients with underlying psychiatric disease and/or drug intoxication. Ketamine, as a dissociative agent, may be an alternative pharmacological consideration for the control of agitation in patients with undifferentiated agitated delirium.
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Cousins R, Anderson D, Dehnisch F, Brown A, McKay S, Glassman ES. It's Time for EMS to Administer Ketamine Analgesia. PREHOSP EMERG CARE 2017; 21:408-410. [DOI: 10.1080/10903127.2016.1263373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mikhail M, Sabri K, Levin AV. Effect of anesthesia on intraocular pressure measurement in children. Surv Ophthalmol 2017; 62:648-658. [PMID: 28438591 DOI: 10.1016/j.survophthal.2017.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/20/2022]
Abstract
Measurement of the intraocular pressure (IOP) is central to the diagnosis and management of pediatric glaucoma. An examination under anesthesia is often necessary in pediatric patients. Different agents used for sedation or general anesthesia have varied effects on IOP. Hemodynamic factors, methods of airway management, tonometry technique, and body positioning can all affect IOP measurements. The most accurate technique is one that reflects the awake IOP. We review factors affecting IOP measurements in the pediatric population and provide recommendations on the most accurate means to measure IOP under anesthesia based on the present literature.
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Affiliation(s)
- Mikel Mikhail
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Kourosh Sabri
- Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Pediatric Eye Research Group, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Alex V Levin
- Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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18
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Patterson AC, Wadia SA, Lorenz DJ, Stevenson MD. Changes in blood pressure and heart rate during sedation with ketamine in the pediatric ED. Am J Emerg Med 2017; 35:322-325. [DOI: 10.1016/j.ajem.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/08/2016] [Accepted: 10/09/2016] [Indexed: 11/25/2022] Open
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Yu Chan JY, Choy BN, Ng AL, Shum JW. Review on the Management of Primary Congenital Glaucoma. J Curr Glaucoma Pract 2016; 9:92-9. [PMID: 26997844 PMCID: PMC4779948 DOI: 10.5005/jp-journals-10008-1192] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/28/2015] [Indexed: 01/30/2023] Open
Abstract
Despite being documented in medical history from over 2400 years ago, primary congenital glaucoma (PCG), being a disease with low incidence rate, remains a challenge to ophthalmologists. The article provides a broad overview on the pathophysiology and diagnostic approach to PCG with major emphasis on the treatment options of PCG. While reviewing on the well-established treatment options, namely goniotomy, trabeculo-tomy and combined trabeculotomy-trabeculectomy, emphasis has also been made to recent updates on secondary treatments: trabeculectomy, antimetabolites, glaucoma-drainage devices and cyclodestructive procedures. It is, however, important to note that the rarity of PCG places limitations on study design, most studies are, thus, retrospective, nonrandomized and have different definitions of surgical success. Ophthalmologists need to interpret the results with critical thinking and formulate individual treatment plans for each patient. How to cite this article: Yu Chan JY, Choy BNK, Alex LK Ng, Shum JWH. Review on the Management of Primary Congenital Glaucoma. J Curr Glaucoma Pract 2015;9(3):92-99.
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Affiliation(s)
- Julia Yan Yu Chan
- Clinical Assistant Professor, Department of Ophthalmology, The University of Hong Kong Hong Kong
| | - Bonnie Nk Choy
- Clinical Assistant Professor, Department of Ophthalmology, The University of Hong Kong Hong Kong
| | - Alex Lk Ng
- Clinical Assistant Professor, Department of Ophthalmology, The University of Hong Kong Hong Kong
| | - Jennifer Wh Shum
- Clinical Assistant Professor, Department of Ophthalmology, The University of Hong Kong Hong Kong
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20
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Krieser D, Kochar A. Paediatric procedural sedation within the emergency department. J Paediatr Child Health 2016; 52:197-203. [PMID: 27062624 DOI: 10.1111/jpc.13081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/11/2015] [Accepted: 11/25/2015] [Indexed: 11/30/2022]
Abstract
Procedural sedation and analgesia in children requires the use of non-pharmacological and pharmacological approaches to facilitate the management of painful procedures. The development of skills in such techniques has mirrored the development of paediatric emergency medicine as a subspecialty. Governance, education and credentialing must facilitate safe sedation practice, using a structured approach, as sedating children in the busy environment of an emergency department is not without risk. Emergency clinicians, patients and caregivers all have a role to play in developing a safe, effective sedation plan.
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Affiliation(s)
- David Krieser
- Department of Emergency Medicine, Sunshine Hospital.,Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria
| | - Amit Kochar
- Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria.,Department of Emergency Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia
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