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      Effect of Anesthesia on Intraocular Pressure Measured With Continuous Wireless Telemetry in Nonhuman Primates

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          Abstract

          Purpose

          To compare the effects of both injectable anesthesia (ketamine/dexmedetomidine versus ketamine/xylazine) and inhalant anesthesia (isoflurane) on IOP using continuous, bilateral IOP telemetry in nonhuman primates (NHP).

          Methods

          Bilateral IOP was recorded continuously using a proven implantable telemetry system in five different sessions at least 2 weeks apart in four male rhesus macaques under two conditions: ketamine (3 mg/kg) with dexmedetomidine (50 μg/kg) or ketamine with xylazine (0.5 mg/kg) for induction, both followed by isoflurane for maintenance. IOP transducers were calibrated via anterior chamber manometry. Bilateral IOP was averaged over 2 minutes after injectable anesthetic induction and again after isoflurane inhalant had stabilized the anesthetic plane, then compared to baseline IOP measurements acquired immediately prior to anesthesia (both before and after initial human contact).

          Results

          When compared to pre-contact baseline measurements, ketamine/dexmedetomidine injectable anesthesia lowers IOP by 1.5 mm Hg on average ( P < 0.05), but IOP did not change with ketamine/xylazine anesthesia. IOP returned to baseline levels shortly after isoflurane gas anesthesia was initiated. However, injectable anesthesia lowered IOP by an average of 5.4 mm Hg when compared to that measured after initial human contact ( P < 0.01).

          Conclusions

          Anesthetic effects on IOP are generally small when compared to precontact baseline but much larger when compared to IOP measures taken after human contact, indicating that IOP is temporarily elevated due to acute stress (similar to a “white coat effect”) and then decreased with anesthetic relaxation. Anesthetic induction with ketamine/xylazine and maintenance with isoflurane gas should be used when IOP is measured postanesthesia.

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          Most cited references26

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          Effect of general anesthetics on IOP in elevated IOP mouse model.

          Elevated intraocular pressure (IOP) is the best recognized risk factor for the pathogenesis of glaucoma and the extent of retinal ganglion cell (RGC) degeneration in glaucoma is closely correlated with the extent of IOP elevation. Therefore, accurately and reliably measuring IOP is critical in investigating the mechanism of pressure-induced RGC damage in glaucoma. However, IOP is measured under general anesthesia in most studies using mouse models and many anesthetics affect the IOP measurements in both human and animals. In the present study, we used a noninvasive approach to measure the IOP of mice with normal and elevated IOP. The approach used mice that were awake and mice that were under general anesthesia. Our results demonstrate that not only the behavioral training enables IOP measurement from conscious mice without using a restrainer, it also significantly improves the consistency and reliability of the IOP measurement. In addition, we provide a direct comparison between awake and anesthetized IOP measurements as a function of time after the induction of general anesthesia with several commonly used anesthetic agents. We found that all tested general anesthetics significantly altered the IOP measurements both in normal eyes and in those with elevated IOP. Therefore, we conclude that behavioral training of mice can provide an approach to measure awake IOP that does not require general anesthesia and thus produces reliable and consistent results. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Intraocular pressure changes: the influence of psychological stress and the Valsalva maneuver.

            The effects of psychological stress and the Valsalva maneuver on short-term variations of intraocular pressure (IOP) were studied in 49 healthy adults. Psychological stress consisted of mental arithmetic tasks presented in counterbalanced order by computer and by the experimenter. Additionally, a standardized Valsalva maneuver was performed (in counterbalanced order with the psychological stressors). IOP was measured with a Goldmann tonometer before and after performance of each stressor. All three stressors transiently and highly significantly increased IOP, although the Valsalva maneuver produced changes of a greater magnitude (10.2 mmHg) than the psychological stressors (1.3 mmHg). Subjective stress ratings and heart rate increased in response to all stressors. There were no effects of task sequence, eye muscle tension, sex, smoking status (some smokers misreported their smoking status), or regular marijuana use, but regular physical exercise was associated with less IOP increase during psychological stress.
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              Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery.

              We studied the effects of a single i.v. dose of dexmedetomidine, a highly selective and specific alpha 2 adrenoceptor agonist, on intraocular pressure (IOP), haemodynamic and sympathoadrenal responses to laryngoscopy and tracheal intubation, and on anaesthetic requirements in ophthalmic surgery. Thirty ASA I-II patients undergoing cataract surgery were allocated randomly to receive either dexmedetomidine 0.6 microgram kg-1 or saline placebo i.v. 10 min before induction of anaesthesia in a double-blind design. After dexmedetomidine there was a 34% (95% confidence interval (CI) 27-43%) reduction in IOP (P less than 0.001) and 62% (CI 57-68%) decrease in plasma noradrenaline concentrations (P less than 0.001). After intubation, maximum heart rate was 18% (CI 3-33%, P = 0.036) and the maximum IOP 27% (CI 11-43%, P = 0.005) less in the dexmedetomidine group compared with the patients treated with placebo. Within 10 min after intubation, maximum systolic and diastolic arterial pressures were also significantly (P = 0.013 and P = 0.020) smaller in the dexmedetomidine group. The induction dose of thiopentone was smaller (23% (CI 20-26%) P = 0.012), and the use of isoflurane or fentanyl supplements during anaesthesia was less frequent in the dexmedetomidine group. The patients premedicated with dexmedetomidine recovered faster from anaesthesia (P = 0.042). These results suggest that dexmedetomidine may be a useful anaesthetic adjunct in ophthalmic surgery.
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                Author and article information

                Journal
                Invest Ophthalmol Vis Sci
                Invest. Ophthalmol. Vis. Sci
                iovs
                Invest Ophthalmol Vis Sci
                IOVS
                Investigative Ophthalmology & Visual Science
                The Association for Research in Vision and Ophthalmology
                0146-0404
                1552-5783
                September 2019
                : 60
                : 12
                : 3830-3834
                Affiliations
                [1 ]Vision Science Graduate Program, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
                [2 ]Department of Ophthalmology and Visual Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
                Author notes
                Correspondence: J. Crawford Downs, Department of Ophthalmology and Visual Sciences The University of Alabama at Birmingham School of Medicine, 1670 University Blvd., VH 390A Birmingham, AL 35294, USA; cdowns@ 123456uab.edu .
                Article
                iovs-60-10-23 IOVS-19-27758R2
                10.1167/iovs.19-27758
                6750888
                31529079
                c48126b4-4258-4c14-b1dd-b7f4547c5266
                Copyright 2019 The Authors

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 25 June 2019
                : 9 August 2019
                Categories
                Clinical and Epidemiologic Research

                intraocular pressure,anesthesia,telemetry
                intraocular pressure, anesthesia, telemetry

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