title: The effects of sevoflurane and ketamine on intraocular pressure in children during examination under anesthesia.
abstract: OBJECTIVE
  We studied the effects on intraocular pressure (IOP) of anesthesia administered during examination under anesthesia (EUA) in children.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  This randomized trial compared IOP after inhaled sevoflurane gas to that after intramuscular ketamine hydrochloride in children undergoing EUA. IOP was measured in 30 eyes with TonoPen XL (Mentor, Inc, Norwell, Massachusetts, USA) as soon as possible after anesthesia induction (T1) and two, four, six, and eight minutes thereafter. At the same times, we recorded systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR).
  
  
  RESULTS
  Compared with the mean IOP at T1, IOP in the sevoflurane group was significantly lower for all measurements from two to eight minutes thereafter (mean decrease in IOP: two minutes = 12%, four minutes = 19%; six minutes = 19%; eight minutes = 17%, all P < or = .01). In the ketamine group, mean IOP was not significantly changed from T1 through six minutes, whereas at eight minutes, it was 7% lower (P = .03). SBP and DBP were significantly lower for sevoflurane than for ketamine at all measurements from two minutes onward, and HR was lower for sevoflurane than for ketamine at two, four, and six minutes.
  
  
  CONCLUSIONS
  IOP measured after ketamine sedation is more likely to represent the awake IOP than that after sevoflurane anesthesia. Changes in SBP, DBP, and HR caused by sevoflurane suggest that hemodynamic alterations may underlie its effects on IOP.
authors.affiliation: Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. dana.blumberg@duke.edu
authors.forename: Dana
authors.initials: D
authors.lastname: Blumberg
authors.forename: Nathan
authors.initials: N
authors.lastname: Congdon
authors.forename: Henry
authors.initials: H
authors.lastname: Jampel
authors.forename: Donna
authors.initials: D
authors.lastname: Gilbert
authors.forename: Richard
authors.initials: R
authors.lastname: Elliott
authors.forename: Richard
authors.initials: R
authors.lastname: Rivers
authors.forename: Beatrice
authors.initials: B
authors.lastname: Munoz
authors.forename: Harry
authors.initials: H
authors.lastname: Quigley
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage*; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D005901:Glaucoma / Q000151:congenital / Q000175:diagnosis; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D007429:Intraocular Pressure / Q000187:drug effects*; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D010808:Physical Examination; D011446:Prospective Studies; D000077149:Sevoflurane; D014065:Tonometry, Ocular
chemical_list: D000700:Analgesics; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D007649:Ketamine