title: [The Effect of Non-Depolarising Muscle Relaxants on Ocular Pulse Amplitude and Intraocular Pressure].
abstract: OBJECTIVE
  In general anaesthesia (GA) for ocular surgery the chosen non-depolarising muscle relaxant has a high influence on the fluctuations of intraocular pressure (IOP) and ocular pulse amplitude (OPA).
  
  
  METHODS
  In 229 patients, who needed GA for their ophthalmic surgery, OPA and IOP were measured with the dynamic contour tonometer (DCT) before and 5 minutes after intubation. For GA, three groups of non-depolarising muscle relaxants, namely, mivacurium (n = 71), atracurium (n = 91) and rocuronium (n = 67) were used.
  
  
  RESULTS
  The IOP decreased by about 4.0 ± 2.3 mmHg using mivacurium in GA, by about 6.1 ± 2.2 mmHg using atracurium and by about 7.4 ± 1.7 mmHg using rocuronium (p < 0.001). The relative decrease of the IOP was 20% for mivacurium, 31% for atracurium and 37% for rocuronium. For mivacurium the OPA decreased from 3.4 ± 1.5 mmHg to 2.2 ± 1.1 mmHg (p < 0.001) in contrast to atracurium (decrease from 3.6 ± 1.5 mmHg to 1.8 ± 0.8 mmHg; p < 0.001) and rocuronium (decrease from 3.1 ± 1.6 mmHg to 1.7 ± 0.9 mmHg; p < 0.001). Mean OPA reduction was lowest with mivacurium (1.3 mmHg) and the highest with atracurium (1.7 mmHg). The mean relative decrease of the OPA was 34% with mivacurium, 46% with atracurium and 43% with rocuronium (p < 0.001). There was no linear correlation between the relative OPA decrease and the relative IOP decrease.
  
  
  CONCLUSIONS
  Risks for ophthalmic surgery may be minimised by avoiding mivacurium in general anaesthesia. Due to its negative effects on IOP and OPA mivacurium does not seem to be suitable for operations with a large opening in the eye such as penetrating keratoplasty and block excision. Rocuronium can be used because it induces a favourised intraoperative decrease of the IOP.
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes Homburg/Saar.
authors.forename: H
authors.initials: H
authors.lastname: Zuche
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar.
authors.forename: E
authors.initials: E
authors.lastname: Morinello
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes Homburg/Saar.
authors.forename: Anja
authors.initials: A
authors.lastname: Viestenz
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes Homburg/Saar.
authors.forename: M F
authors.initials: MF
authors.lastname: Fiorentzis
authors.affiliation: Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar.
authors.forename: T
authors.initials: T
authors.lastname: Volk
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes Homburg/Saar.
authors.forename: B
authors.initials: B
authors.lastname: Seitz
authors.affiliation: Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes Homburg/Saar.
authors.forename: Arne
authors.initials: A
authors.lastname: Viestenz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage*; D011674:Pulse; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003473:Neuromuscular Nondepolarizing Agents