Intraocular pressure changes during rapid sequence induction and intubation: A comparison of rocuronium, atracurium, and succinylcholine

Study Objective: To compare changes in intraocular pressure (IOP) during ra pid sequence induction and intubation following rocuronium, succinylcholine , and atracurium. Design: Open-label, prospective, randomized study. Setting: Operating room at the Eye Foundation Hospital (University of Alaba ma at Birmingham) Patients: 45 ASA physical status I, II, and III patients, aged 18 to 65 yea rs, scheduled for elective eye surgery with general anesthesia. Interventions: Anesthesia was rapidly induced in unpremedicated patients wi th a fixed combination of midazolam 0.025 mg/kg, alfenlanil 0.025 mg/kg, an d propofol 1.5 mg/kg. Intubation was performed, as clinically indicated app roximately GO seconds following administration of rocuronium 0.6 mg/kg; atr acurium 0.5 mg/kg, or succinylcholine I to 1.5 mg/kg. Measurements and Main Results: Intraocular pessure was measured before indu ction of anesthesia (baseline), following anesthesia induction and administ ration of muscle relaxant (before intubation, and after intubation). The pe rcent change in IOP from baseline was significantly decreased in the rocuro nium group compared with the succinylcholine group, (p = 0.046) before intu bation. This trend continued after intubation, but the difference was no lo nger significant (p = 0.070). Intubation scores for rocuronium and succinyl choline groups were similar, and both scores were superior to that for the atracurium group (p = 0.002). Conclusion: Intraocular, pressure can be controlled during emergency induct ion of aesthesia and intubation with adequate depth of anesthesia and muscl e relaxation. Rocuronium, succinylcholine, and atracurium all provided suff icient muscle relaxation to achieve successful intubation and no increase i n IOP. However, rocuronium 0.6 mg/kg provided significantly better intubati ng conditions compared with atracurium, and it resulted in a significantly greater decrease in IOP compared with baseline than succinylcholine. (C) 19 99 by Elsevier Science Inc.