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Şenocak MG, Yanmaz LE. Effects of propofol alone or in combination with ketamine on intraocular pressure in unpremedicated dogs. Vet Ophthalmol 2024; 27:139-147. [PMID: 37395174 DOI: 10.1111/vop.13127] [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: 03/14/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To determine the effects of propofol (P) alone and in combination with ketamine (KP) at ratios of 1:1, 1:2, and 1:3 on intraocular pressure (IOP) in unpremedicated dogs. ANIMALS STUDIED A total of 28 cross-bred healthy dogs. PROCEDURES Dogs were randomly assigned to one of four groups (n = 7 per group) to receive intravenous P or KP at 1:1, 1:2, and 1:3 ratios, respectively. The infusion was administered at 0.6 mg/kg/min for 60 min. IOP, cardiorespiratory variables, rectal temperature (RT), and pedal reflex were recorded every 5 min for 60 min, starting from baseline (BL). RESULTS There was a statistically significant increase in IOP in all groups: P (p = .011), KP 1:1 (p = .003), KP 1:2 (p = .023), and KP 1:3 (p = .008). The IOP increase was less pronounced in the KP 1:2 group and was only significant (p = .023) at T45 compared with BL. A significant correlation was observed between IOP and SpO2 in P (r = -.215, p = .02), KP 1:2 (r = -.579, p < .01), and KP 1:3 (r = -.402, p < .01) groups. IOP significantly increased due to decreased SpO2 below 86.5% (p < .05). CONCLUSIONS Propofol alone and in combination with ketamine may increase preexisting IOP in unpremedicated dogs. SpO2 levels below 86.5% may trigger an increase in IOP. Administering KP in a 1:2 ratio at an infusion rate of 0.6 mg/kg/min does not significantly alter IOP for under 45 min in unpremedicated dogs with sufficient oxygenation.
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Affiliation(s)
- Mümin Gökhan Şenocak
- Department of Surgery, Faculty of Veterinary Medicine, Atatürk University, Erzurum, Turkey
| | - Latif Emrah Yanmaz
- Department of Surgery, Faculty of Veterinary Medicine, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
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Ahmed M, Krishna Y, Popova P, Herbert R, Sidaras G, Choudhary A, Kaye SB. Low-Dose Propofol with Peribulbar Anaesthesia for Cataract Surgery. J Clin Med 2023; 12:jcm12072742. [PMID: 37048825 PMCID: PMC10095169 DOI: 10.3390/jcm12072742] [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: 12/10/2022] [Revised: 03/07/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP.
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Affiliation(s)
- Mahmoud Ahmed
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Yamini Krishna
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Petya Popova
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Rose Herbert
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Gediminas Sidaras
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Anshoo Choudhary
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Stephen B Kaye
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Antończyk A, Kubiak-Nowak D, Borawski W, Kiełbowicz Z, Danielewska ME. The effect of changes in cardiovascular activity on corneal biomechanics and pulsation in rabbits. Sci Rep 2020; 10:22249. [PMID: 33335224 PMCID: PMC7747746 DOI: 10.1038/s41598-020-79219-9] [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: 04/28/2020] [Accepted: 12/04/2020] [Indexed: 11/24/2022] Open
Abstract
The aim was to assess the relationships between cardiovascular activity, corneal pulse characteristics, and corneal biomechanics in rabbits. Seventeen rabbits were randomly assigned to one of two anesthetic regimens to induce differences in arterial blood pressure and heart rate. Experimental protocol included measuring blood flow parameters in the ophthalmic artery by color Doppler imaging, corneal biomechanical parameters using a non-contact tonometer Corvis ST, and the corneal pulse (CP) signal using a non-contact ultrasonic technique. Statistically significantly lower mean values of normalized amplitudes of higher CP harmonics and changes in eight of the twelve corneal biomechanical parameters were observed in the rabbit group with lower arterial blood pressure and higher heart rate, intraocular pressure, and resistive index. The results of partial correlations showed that the CP signal energy and amplitude of its first harmonic correlate with the resistive index, diastolic and mean arterial pressures, whereas no statistically significant correlation was found between any of the CP parameters and intraocular pressure. Our pilot study indicates, for the first time, that non-contact and continuous measuring of corneal pulse allows indirectly assessing changes in cardiovascular activity when the confounding effect of intraocular pressure is eliminated.
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Affiliation(s)
- Agnieszka Antończyk
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 51, 50-366, Wrocław, Poland.
| | - Dominika Kubiak-Nowak
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 51, 50-366, Wrocław, Poland
| | - Wojciech Borawski
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 51, 50-366, Wrocław, Poland
| | - Zdzisław Kiełbowicz
- Department of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 51, 50-366, Wrocław, Poland
| | - Monika E Danielewska
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370, Wrocław, Poland
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Czorlich P, Krätzig T, Kluge N, Skevas C, Knospe V, Spitzer MS, Dreimann M, Mende KC, Westphal M, Eicker SO. Intraocular pressure during neurosurgical procedures in context of head position and loss of cerebrospinal fluid. J Neurosurg 2019; 131:271-280. [PMID: 30141760 DOI: 10.3171/2018.3.jns173098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/19/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perioperative visual loss (POVL) is a rare but serious complication in surgical disciplines, especially in spine surgery. The exact pathophysiology of POVL remains unclear, but elevated intraocular pressure (IOP) is known to be part of it. As POVL is rarely described in patients undergoing intracranial or intradural surgery, the aim of this study was to investigate the course of IOP during neurosurgical procedures with opening of the dura mater and loss of CSF. METHODS In this prospective, controlled trial, 64 patients fell into one of 4 groups of 16 patients each. Group A included patients undergoing spine surgery in the prone position, group B patients had intracranial procedures in the prone position, and group C patients were treated for intracranial pathologies in a modified lateral position with the head rotated. In groups A-C, the dura was opened during surgery. Group D patients underwent spine surgeries in the prone position with an intact dura. IOP was measured continuously pre-, peri-, and postoperatively. RESULTS In all groups, IOP decreased after induction of anesthesia and increased time dependently after final positioning for the operation. The maximum IOP in group A prior to opening of the dura was 28.6 ± 6.2 mm Hg and decreased to 23.44 ± 4.9 mm Hg directly after dura opening (p < 0.0007). This effect lasted for 30 minutes (23.5 ± 5.6 mm Hg, p = 0.0028); after 60 minutes IOP slowly increased again (24.5 ± 6.3 mm Hg, p = 0.15). In group B, the last measured IOP before CSF loss was 28.1 ± 5.0 mm Hg and decreased to 23.5 ± 6.1 mm Hg (p = 0.0039) after dura opening. A significant IOP decrease in group B lasted at 30 minutes (23.6 ± 6.0 mm Hg, p = 0.0039) and 60 minutes (23.7 ± 6.0 mm Hg, p = 0.0189). In group C, only the lower eye showed a decrease in IOP up to 60 minutes after loss of CSF (opening of dura, p = 0.0007; 30 minutes, p = 0.0477; 60 minutes, p = 0.0243). In group D (control group), IOP remained stable throughout the operation after the patient was prone. CONCLUSIONS This study is the first to demonstrate that opening of the dura with loss of CSF during neurosurgical procedures results in a decrease in IOP. This might explain why POVL predominantly occurs in spinal but rarely in intracranial procedures, offers new insight to the pathophysiology of POVL, and provides the basis for further research and treatment of POVL.German Clinical Trials Register (DRKS) no.: DRKS00007590 (drks.de).
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Affiliation(s)
| | | | | | | | | | | | - Marc Dreimann
- 3Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kelly DJ, Farrell SM. Physiology and Role of Intraocular Pressure in Contemporary Anesthesia. Anesth Analg 2018; 126:1551-1562. [DOI: 10.1213/ane.0000000000002544] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Costa D, Leiva M, Moll X, Aguilar A, Peña T, Andaluz A. Alfaxalone versus propofol in dogs: a randomised trial to assess effects on peri-induction tear production, intraocular pressure and globe position. Vet Rec 2015; 176:73. [DOI: 10.1136/vr.102621] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Daniel Costa
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Barcelona 08193 Spain
| | - Marta Leiva
- Servei d'Oftalmologia de la Fundació Hospital Clínic Veterinari & Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Barcelona 08193 Spain
| | - Xavier Moll
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Barcelona 08193 Spain
| | - Adrià Aguilar
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Barcelona 08193 Spain
| | - Teresa Peña
- Servei d'Oftalmologia de la Fundació Hospital Clínic Veterinari & Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Barcelona 08193 Spain
| | - Anna Andaluz
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Bellaterra Barcelona 08193 Spain
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Pharmacologically and Edinger-Westphal stimulated accommodation in rhesus monkeys does not rely on changes in anterior chamber pressure. Exp Eye Res 2014; 125:244-55. [PMID: 24983145 DOI: 10.1016/j.exer.2014.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/14/2014] [Accepted: 06/05/2014] [Indexed: 11/21/2022]
Abstract
This study was undertaken to understand the role of anterior chamber pressure (ACP) during pharmacological and Edinger-Westphal (EW) stimulated accommodation in anesthetized monkeys. Experiments were performed on one iridectomized eye each of 7 anesthetized adolescent rhesus monkeys. Accommodation was induced by EW stimulation (n = 2) and intravenous administration of 0.25-4.0 mg/kg pilocarpine (n = 6). Accommodative refractive and biometric changes were measured with continuous 60 Hz infrared photorefraction (n = 6) and 100 Hz A-scan ultrasound biometry (n = 1). An ocular perfusion system was used to measure and manipulate ACP. Pressure was recorded via a 27-gauge needle in the anterior chamber connected to a pressure transducer (n = 7). The needle was also connected to a fluid reservoir to allow ACP to be manipulated and clamped (n = 4) by raising or lowering the fluid reservoir. In all six pharmacologically stimulated monkeys ACP increased during accommodation, from 0.70 to 2.38 mmHg, four of which showed pressure decreases preceding the pressure increases. Two eyes also showed increases in ACP during EW-stimulated accommodation of 2.8 and 7.2 mmHg. ACP increased with increasing EW stimulus amplitudes (n = 2). Clamping or externally manipulating ACP had no effect on resting refraction or on EW and pharmacologically stimulated accommodation in four eyes. The results show that EW stimulated and pharmacologically stimulated accommodation do not rely on ACP in rhesus monkeys.
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Torres MD, Andaluz A, García F, Fresno L, Moll X. Effects of an intravenous bolus of alfaxalone versus propofol on intraocular pressure in sheep. Vet Rec 2012; 170:226. [DOI: 10.1136/vr.100399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M-D. Torres
- Ophthalmology Service; Ars Veterinaria Hospital; Barcelona 08023 Spain
| | - A. Andaluz
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària. Universitat Autònoma de Barcelona; Barcelona Spain
| | - F. García
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària. Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Fresno
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària. Universitat Autònoma de Barcelona; Barcelona Spain
| | - X. Moll
- Departament de Medicina i Cirurgia Animals; Facultat de Veterinària. Universitat Autònoma de Barcelona; Barcelona Spain
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Oei-Lim VLB, Dijkgraaf MGW, de Smet MD, White M, Kalkman CJ. Does Cerebral Monitoring Improve Ophthalmic Surgical Operating Conditions During Propofol-Induced Sedation? Anesth Analg 2006; 103:1189-95. [PMID: 17056953 DOI: 10.1213/01.ane.0000244321.38023.92] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sudden movements from over-sedation during ophthalmic surgery can be detrimental to the eye. Bispectral index (BIS) and middle-latency auditory-evoked potentials (Alaris AEP index, AAI) were reported to be accurate indicators for the level of sedation and loss of consciousness. We assessed these monitors during sedation with special emphasis on preventing over-sedation. One-hundred patients scheduled for elective eye surgery were sedated with target-controlled propofol infusion and randomly allocated to BIS-guided, AAI-guided, BIS/AAI-guided, or clinically guided groups (n = 25 each). The initial target concentration was 0.5 microg x mL(-1) in patients >70 yr and 1.0 microg x mL(-1) in all other patients. The concentration was increased every 3 min by 0.1 or 0.2 microg x mL(-1), respectively until the patient had reached a BIS value of 75 (range 70-90) or an AAI of 40 (range 35-60). The surgeon who was blinded to group allocation assessed treatment quality after the procedure. Sedation was converted into general anesthesia in four patients because of excessive head movements. BIS was out of range 7% of the time vs 58% for AAI. No significant differences in treatment quality were observed among the four groups. We conclude that propofol sedation, guided by BIS or AAI monitoring, did not enhance ophthalmic surgical operating conditions over sedation guided by clinical observation only.
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Agents for sedation in ophthalmic surgery: A review of the pharmacodynamics and clinical applications. ACTA ACUST UNITED AC 2006. [DOI: 10.1016/j.cacc.2006.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Lauretti GR, Lauretti CR, Lauretti-Filho A. Propofol decreases ocular pressure in outpatients undergoing trabeculectomy. J Clin Anesth 1997; 9:289-92. [PMID: 9195351 DOI: 10.1016/s0952-8180(97)00012-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVE To examine the effect of a continuous low-dose intravenous (i.v.) infusion of propofol on ocular pressure in outpatients undergoing trabeculectomy. DESIGN Randomized, prospective study. SETTING Teaching hospital. PATIENTS 40 unpremedicated outpatients with history of primary open angle glaucoma undergoing trabeculectomy. INTERVENTIONS In the operating room, an infusion of 5% dextrose into a peripheral vein was started. The propofol group (n = 20) received 0.5 mg/kg i.v. propofol bolus followed immediately by a continuous 0.5 mg/kg/hr infusion. The control group (n = 20) received only the dextrose solution. A peribulbar block was performed with bupivacaine with added adrenaline, plus lidocaine. The ocular pressure (tonometer) on the eye undergoing trabeculectomy and the other eye, blood pressure (BP), and heart rate (HR) were measured at the following times: (1) preoperatively; (2) 2 minutes; (3) 5 minutes; (4) 10 minutes; (5) 15 minutes after propofol bolus administration for the propofol group (approximately 4 minutes after the peribulbar blockade on the eye undergoing surgery for the propofol and control groups). MEASUREMENTS AND MAIN RESULTS Ocular pressure decreased 2 minutes after propofol infusion (p < 0.0001) and remained significantly lower than in the control group throughout the study period. All patients remained awake and cooperative during all procedures. Mean BP and HR were kept constant throughout the study. CONCLUSION Low-dose propofol sedation resulted in a decrease in ocular pressure, was quick in onset, and was unrelated to BP and HR. The decrease in ocular pressure may be due to relaxation of extraocular muscles by propofol.
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Affiliation(s)
- G R Lauretti
- Department of Surgery, Orthopedics and Traumatology, Hospital of the University of São Paulo, Brazil
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