PROPOFOL AND ALFENTANIL PREVENT THE INCREASE IN INTRAOCULAR-PRESSURE CAUSED BY SUCCINYLCHOLINE AND ENDOTRACHEAL INTUBATION DURING A RAPID-SEQUENCE INDUCTION OF ANESTHESIA

The increase in intraocular pressure (IOP) associated with succinylcho line (Sch) has made its use in patients with open globe injuries contr oversial. Studies that have examined techniques to prevent the increas e in IOP due to Sch have shown a larger increase in IOP from the stimu lus of laryngoscopy and endotracheal intubation. The purpose of our st udy was to examine whether the combination of propofol and alfentanil would prevent the increase in IOP due to Sch as well as endotracheal i ntubation during a rapid sequence induction of anesthesia. Sixty patie nts were randomized to receive either thiopental 5 mg/kg and Sch 1.5 m g/kg (Group I), propofol 2 mg/kg and Sch 1.5 mg/kg (Group II), or prop ofol 2 mg/kg, alfentanil 40 mu g/kg, and Sch 1.5 mg/kg (Group III). Th e IOP was measured continuously from baseline awake (control) values u ntil 15 s after successful intubation. All three groups had a signific ant decrease in IOP with the induction of anesthesia. Succinylcholine produced a consistant increase in IOP from the postinduction low in Gr oups I and II, but this increase was not significantly higher than bas eline. The postintubation IOPs in Groups I and II were significantly h igher than baseline (P < 0.001). During the entire study period, the I OP in Group III never increased above baseline. The IOP in Groups I an d II had already begun to decline by 15 s postintubation, suggesting t hat laryngoscopy and intubation have the greatest effect on increasing IOP. We conclude that the combination of propofol and alfentanil prev ents the increase in IOP from Sch as well as the increase associated w ith endotracheal intubation during a rapid sequence induction of anest hesia.