title: Intraocular pressure changes associated with tracheal extubation: Comparison of sugammadex with conventional reversal of neuromuscular blockade.
abstract: OBJECTIVE
  To compare the effects of neostigmine/atropine combination and sugammadex on intraocular pressure during tracheal extubation period.
  
  
  METHODS
  The single-blind prospective randomised controlled study was conducted at Ordu University Research and Training Hospital from August to October 2014, and comprised patients who were randomly assigned to 2 groups according to the agent used for reversal of neuromuscular blockade. Group N received 0.05mgkg-1 neostigmine and 0.02 mgkg-1 atropine and the patients in Group S received 2mgkg-1 sugammadex intravenously. Heart rate, mean arterial pressure and intraocular pressure were measured at baseline, before the induction (T1), after the application of reversal agent (T2), and 1 (T3), 3 (T4), 5 (T5) and 10 (T6) minutes after the extubation. SPSS 16 was used for statistical analysis.
  
  
  RESULTS
  There were 36 patients in the study; 18(50%) in each group. There was no significant difference between the groups in terms of age, gender and body mass index (p>0.05 each). Intraocular pressure was significantly higher when the baseline level was compared with all measurement intervals in Group N (p<0.05 each). In Group S, it showed no significant difference at T2 (p>0.05) whereas it was significantly higher at all other measurement intervals (p<0.05 each). Intergroup comparisons showed statistically significant difference in heart rate and mean arterial pressure levels at T2 interval which were higher in Group N (p<0.01). Intraocular pressure levels at T2 and T3 intervals were significantly higher in Group N (p<0.01).
  
  
  CONCLUSIONS
  Lower end-extubation intraocular pressure levels were obtained when sugammadex was used as a neuromuscular block reversal agent in comparison with neostigmine-atropine combination. Sugammadex may be a better option for the reversal of neuromuscular blockade and intraocular pressure increase should be avoided in patients with glaucoma or penetrating eye injury.
authors.affiliation: Department of Anesthesiology, Ordu University, School of Medicine, Ordu, Turkey.
authors.forename: Ozgur
authors.initials: O
authors.lastname: Yagan
authors.affiliation: Department of Ophthalmology, Ordu University, School of Medicine, Ordu, Turkey.
authors.forename: Refika Hande
authors.initials: RH
authors.lastname: Karakahya
authors.affiliation: Department of Anesthesiology, Ordu University, School of Medicine, Ordu, Turkey.
authors.forename: Nilay
authors.initials: N
authors.lastname: Tas
authors.affiliation: Department of Anesthesiology, Ordu University, School of Medicine, Ordu, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Canakci
authors.affiliation: Department of Anesthesiology, Dokuz Eylul University, School of Medicine, Izmir, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Hanci
authors.affiliation: Department of Anesthesiology, Dokuz Eylul University, School of Medicine, Izmir, Turkey.
authors.forename: Bulent Serhan
authors.initials: BS
authors.lastname: Yurtlu
mesh_terms: D000328:Adult; D060666:Airway Extubation; D001285:Atropine / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use; D019148:Neuromuscular Blockade; D010276:Parasympatholytics / Q000627:therapeutic use; D010277:Parasympathomimetics / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000627:therapeutic use*
chemical_list: D010276:Parasympatholytics; D010277:Parasympathomimetics; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D001285:Atropine
keywords: Neostigmine; Anaesthetics; Intraocular pressure; Sugammadex.