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Muscle Relaxants as a Risk Factor for Vis-à-tergo During Penetrating Keratoplasty: A Prospective Interventional Study

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Abstract

Introduction

This study aimed to investigate the influence of three muscle relaxants on intraocular pressure (IOP), ocular pulse amplitude (OPA), and vis-à-tergo (VAT) in patients undergoing penetrating keratoplasty (PKP) under general anesthesia.

Methods

Ninety-five patients undergoing PKP were included in this prospective single-center interventional study. IOP and OPA were measured with a dynamic contour tonometer before and 5 min after onset of general anesthesia. Mivacurium (n = 30), atracurium (n = 35), and rocuronium (n = 30) were administered as nondepolarizing muscle relaxants. VAT was assessed 15 min after surgery had begun.

Results

When mivacurium was used, IOP decreased by 2.2 mmHg [standard deviation (SD) ±2.2 mmHg; p < 0.001]. Atracurium decreased the IOP by an average of 5.8 mmHg (SD ±1.8 mmHg; p < 0.001) and rocuronium caused an IOP reduction of 7.2 mmHg (SD ±2 mmHg; p < 0.001). The relative IOP decrease was 12% with mivacurium, 29% with atracurium, and 37% with rocuronium (p < 0.001). OPA decreased by 0.6 mmHg with mivacurium (SD ±0.6 mmHg; 26%; p < 0.001), 1.3 mmHg with atracurium (SD ±1.3 mmHg; 40%; p < 0.001), and 1.2 mmHg with rocuronium (SD ±0.7 mmHg; 42%; p < 0.001). The relative OPA decrease was 26% with mivacurium, 40% with atracurium, and 42% with rocuronium (p < 0.001). VAT occurred in 36% of cases. Mivacurium was used in 77% of these cases, atracurium in 26%, and rocuronium in 6.6% (p < 0.001).

Conclusions

Mivacurium is associated with a higher risk of VAT during PKP. Therefore, atracurium or rocuronium may minimize complications in ocular surgery with large incisions.

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References

  1. Groh M, Seitz B, Händel A, et al. Expulsive haemorrhage in perforating keratoplasty—incidence and risk factors. Klin Monatsbl Augenheilkd. 1999;215:152–7.

    Article  CAS  PubMed  Google Scholar 

  2. Gloor B, Kalman A. Choroidal effusion and expulsive haemorrhage in penetrating interventions—lesson from 26 patients. Klin Monatsbl Augenheilkd. 1993;202:224–37.

    Article  CAS  PubMed  Google Scholar 

  3. Rex S. Anaesthesia in ophthalmology. Anaesthesist. 2001;50:798–815.

    Article  CAS  PubMed  Google Scholar 

  4. Zuche H, Morinello E, Viestenz A, et al. Reduction of intraocular pressure and ocular pulse amplitude during general anaesthesia. Ophthalmologe. 2014;12:764–9.

    Google Scholar 

  5. Zuche H, Morinello E, Viestenz A, et al. The effect of non-depolarising muscle relaxants on ocular pulse amplitude and intraocular pressure. Klin Monatsbl Augenheilkd. 2015;232:1397–402.

    Article  CAS  PubMed  Google Scholar 

  6. Seitz B, El-Husseiny M, Langenbucher A, Szentmáry N. Prophylaxis and management of complications in penetrating keratoplasty. Ophthalmologe. 2013;110:605–13.

    Article  CAS  PubMed  Google Scholar 

  7. Knecht P, Schmid U, Romppainen T, et al. Hand-held dynamic contour tonometry. Acta Ophthalmol. 2011;89:132–7.

    Article  PubMed  Google Scholar 

  8. Zinkernagel M, Ebneter A. Acetazolamide influences ocular pulse amplitude. J Ocul Pharmacol Ther. 2009;25:141–4.

    Article  CAS  PubMed  Google Scholar 

  9. Bertelman T, Langanke S, Potstawa M, Strempel I. Can dynamic contour tonometry and ocular pulse amplitude help to detect severe cardiovascular pathologies? Clin Ophthalmol. 2014;8:1317–21.

    Article  Google Scholar 

  10. Grieshaber MC, Katamay R, Gugleta K, Kochkorov A, Flammer J, Orgül S. Relationship between ocular pulse amplitude and systemic blood pressure measurements. Acta Ophthalmol. 2009;87:329–34.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors.

All named authors meet the International Committee of Medical Journal Editors criteria for authorship for the article, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Miltiadis Fiorentzis, Emanuela Morinello, Anja Viestenz, Hanna Zuche, Berthold Seitz and Arne Viestenz have nothing to disclose.

Compliance with Ethics Guidelines

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013. The study was approved and registered by the Ethics Committee of the Saarland Medical Association (no. 144/3). Informed consent was obtained from all patients for their being included in the study.

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Author notes

  1. Miltiadis Fiorentzis and Emanuela Morinello contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany

    Miltiadis Fiorentzis, Anja Viestenz & Arne Viestenz

  2. Department of Anaesthesiology and Intensive Care, Saarland University Medical Center, Homburg/Saar, Germany

    Emanuela Morinello

  3. Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany

    Anja Viestenz, Hanna Zuche, Berthold Seitz & Arne Viestenz

Authors
  1. Miltiadis Fiorentzis
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  2. Emanuela Morinello
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  3. Anja Viestenz
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  4. Hanna Zuche
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  5. Berthold Seitz
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  6. Arne Viestenz
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Correspondence to Miltiadis Fiorentzis.

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Fiorentzis, M., Morinello, E., Viestenz, A. et al. Muscle Relaxants as a Risk Factor for Vis-à-tergo During Penetrating Keratoplasty: A Prospective Interventional Study. Adv Ther 34, 2674–2679 (2017). https://doi.org/10.1007/s12325-017-0637-1

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  • DOI: https://doi.org/10.1007/s12325-017-0637-1

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