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

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Abstract

Purpose

To investigate the agreement between the intraocular pressure (IOP) measurements in the awake condition and under different stages of general inhalational anesthesia using sevoflurane in both glaucomatous and normal children.

Methods

A prospective study was performed on 43 glaucomatous children and 30 age-matched controls. Baseline IOP of one eye was measured immediately before general anesthesia using Perkins tonometer and then re-measured under light, intermediate, and deep anesthesia, and then after intubation. Depth of anesthesia was determined using bispectral index pediatric sensor. The agreement between the IOP measurements before and during different stages of anesthesia was analyzed using Bland–Altman plots. Systematic and proportionate deviations between the IOP measurements were analyzed.

Results

The mean age was 58.6 ± 41.99 months. The mean IOP was significantly lower at all stages of anesthesia in both groups. The coefficient of variation was over 20% in all measurements under anesthesia. For all IOP measurements during anesthesia, the limits of agreement were > 7 mmHg difference in the control group and > 20 mmHg in the glaucomatous group. The best agreement was with the IOP measurement after intubation (mean limit of agreement of -1.4 mmHg, 1.96 s range, −8.8–6 mm Hg) in the control group and with the IOP measurement under intermediate anesthesia (mean limit of agreement of −4.2 mmHg, 1.96 s range, −15.1–6.8 mm Hg) in the glaucomatous group.

Conclusions

Inhalational anesthesia has variable effects on IOP measurement at all stages of anesthesia. Caution should be taken when extrapolating the true IOP from these measurements.

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Data availability

Data are available from the corresponding author upon request.

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Authors and Affiliations

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

    Engy Samy, Yasmine El Sayed, Ahmed Awadein & Maha Gamil

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  1. Engy Samy
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  2. Yasmine El Sayed
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  3. Ahmed Awadein
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Corresponding author

Correspondence to Ahmed Awadein.

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Conflicts of interest

The author declared that there is no conflict of interest.

Ethical Approval

The study protocol was approved by Cairo University Research Ethics Committee. The study and data collection conformed to all local laws and were compliant with the principles of the Declaration of Helsinki.

Consent to participate

Written informed consent was obtained from the guardians of all children included in the study.

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All authors approved the final version of the manuscript.

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Supplementary Information

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10792_2021_1800_MOESM1_ESM.tif

Deming regression analysis showing the systematic bias, represented by the intercept, and the proportionate bias, represented by the slope, between the IOP measured under awake condition and that measured under different stages of anesthesia in the control group (TIF 1239 KB)

10792_2021_1800_MOESM2_ESM.tif

Deming regression analysis showing the systematic bias, represented by the intercept, and the proportionate bias, represented by the slope, between the IOP measured under awake condition and that measured under different stages of anesthesia in the glaucomatous group (TIF 1318 KB)

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Samy, E., El Sayed, Y., Awadein, A. et al. Effect of general inhalational anesthesia on intraocular pressure measurements in normal and glaucomatous children. Int Ophthalmol 41, 2455–2463 (2021). https://doi.org/10.1007/s10792-021-01800-6

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  • DOI: https://doi.org/10.1007/s10792-021-01800-6

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