GA induction using propofol and sufentanil with esketamine does not elevate IOP during strabismus surgery in children

Maintaining a stable IOP within the normal range is considered important during ophthalmic surgery. Esketamine due to its good sedative and analgesic effects is a commonly used drug in pediatric general anaesthesia. However, it has limited application in ophthalmic surgery because it can increase IOP. The effect of esketamine in combination with other common anesthetics on IOP has not been studied well.

In their study, published in BMC Anesthesiology, the researchers found a significant reduction in IOP with the combination of propofol with sufentanil during the induction of general anaesthesia.

A dose of 0.5 mg/kg esketamine was found to elevate IOP compared to the low-dose and control groups after induction, however, the IOP remained lower than baseline. There was a little effect of 0.25 mg/kg esketamine combined with propofol and sufentanil.

Based on the findings, Ruiqiang Sun, Department of Anesthesiology, Tianjin Eye Hospital, Tianjin, China, and colleagues advocate that a maximum dose of 0.5 mg/kg esketamine in combination with sufentanil and propofol will not increase IOP compared to baseline in pediatric strabismus surgery.

The study was conducted to investigate the effect of different esketamine doses combined with propofol and sufentanil on IOP during intravenous induction of general anaesthesia for pediatric strabismus surgery.

For this purpose, the researchers recruited 181 children with strabismus undergoing unilateral eye surgery under general anaesthesia. IV induction included the use of propofol 3 mg/kg, sufentanil 0.1 µg/kg, and esketamine.

Based on the esketamine dosage, the patients were randomly allocated into three groups: 62 to esketamine low (EL) group with 0.25 mg/kg; 60 to esketamine high (EH) group with 0.5 mg/kg; and 50 to the normal saline (NS) group.

Respiratory parameters, hemodynamic parameters, and IOP were recorded of the non-surgical eye and compared among 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).

The study revealed the following findings:

· There were no significant differences in gender, age, 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.

· 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.

· 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.

The research team felt the need for further studies to determine the suitability and efficacy of esketamine use in children with other eye conditions, such as glaucoma.

"Anesthesiologists should choose the optimal combination of anaesthetics based on individual clinical conditions and surgical requirements," the researchers concluded.

Reference:

Luo, J., Yin, K., Zhao, D. et al. 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 23, 275 (2023). https://doi.org/10.1186/s12871-023-02238-2