Intraocular pressure and heart rate changes during tracheal intubation versus laryngeal mask airway insertion in infants with congenital glaucoma under sevoflurane anesthesia

Background: tracheal intubation is a time-tested method to achieve the airway control in anesthesia practice and resuscitation, However it is associated with significant cardiovascular response and increase IOP. The use of laryngeal mask airway [LMA] as an alternative to tracheal intubation has attracted the attention of several workers with regard to haemodynamics and IOP changes

Aims: to evaluate the intraocular pressure and heart rate changes subsequent to insertion of laryngeal mask or tracheal tube in infants with congenital glaucoma under sevoflurane anesthesia

Patient and Methods: The study was conducted on 20 infants with congenital glaucoma ASA I. Pre-operative assessment was done. Sevoflurane was used for induction and maintenance. According to the airway device used, patients were randomly classified into two groups: group 1 [n=10] tracheal tube [TT] was used, and group 2 [n=10] LMA was used . Heart rate and IOP were measured before induction [basal] and after induction of anesthesia and at 1, 3, 5 minutes after insertion of the airway device

Results: A statistically significant reduction in IOP after induction and at 1, 3, 5 minutes occurred in both groups compared to basal values, the reduction was more in the group 2 [LMA] than group 1 [TT]. Heart rate decreased significantly after induction in TT group 1 and at 3, 5 minutes in LMA group 2 compared to basal values

Conclusion: Laryngeal mask airway can be an alternative to tracheal tube in elective glaucoma surgery in infants. Sevoflurane pevents the rise in IOP and heart rate following the insertion of laryngeal mask airway and tracheal tube in these infants

Effects of locally applied lidocaine or ropivacaine on occulocardiac reflex in pediatric strabismus surgery

Thirty children aged from 3-14 years, ASA I or II, requiring the correction of strabismus under general anesthesia were included in this study. A preoperative assessment was performed, the children were fasted for 6-8 hours from solid food and 3-4 hours for clear liquid. No premeditation was given. Anesthesia was induced by thiopentone 3-5 mg/kg and tracheal intubation was facilitated by atracurium 0.5-0.6 mg/kg and anesthesia was maintained with N2O oxygen 2:1 with the addition of isoflurane 0.6-1%. Controlled ventilation was used to maintain end-tidal carbon dioxide [EtCO2] at an accepted level. The patients were randomly categorized into three groups [10 patients each] according to the drug applied locally on the extra ocular muscle as follows: Group I [control group] received saline, group II [lidocaine group] received 1 mg/kg lidocaine [2%] and group III [ropivacaine group] received ropivacaine [0.75%] 1 mg/kg [4-5 ml volume]. It was concluded that lidocaine and ropivacaine [in a dose of 1 mg/kg] applied locally to the extra ocular muscles can be used to reduce the incidence of the oculocardiac reflex [OCR] during strabismus surgery in children