Effects of Cisatracurium, Rocuronium, and Mivacurium on Intraocular Pressure During Induction of General Anesthesia in Ophthalmic Surgery

Abstract

Objective

Maintaining intraocular pressure (IOP) is important in preventing ocular complications in patients undergoing ophthalmic surgery for general anesthesia. The effects of non-depolarizing neuromuscular blockers on IOP remain unclear. The present study compared the effects of cisatracurium, rocuronium, and mivacurium on IOP during induction of general anesthesia in vitreous retinal surgery.

Materials and Methods

In this prospective randomized double-blinded study, 133 patients undergoing vitreous retinal surgery were randomized into one of the three groups: Group cisatracurium (n=45), Group rocuronium (n=44), or Group mivacurium (n=44). Each drug (cisatracurium 0.1 mg kg⁻¹ in Group cisatracurium, rocuronium 0.6 mg kg⁻¹ in Group rocuronium, and mivacurium 0.2 mg kg⁻¹ in Group mivacurium) was administered during induction of anesthesia. IOP and hemodynamic parameters were measured at 1 min before anesthesia induction (T0). Bispectral index (BIS) was maintained between 45 and 55 after propofol administration (T1). Train-of-four stimulation (TOF) was below 0 after muscle relaxant administration (T2) and after laryngeal mask implantation (T3).

Results

Both ipsi-operative and control-operative IOP at T1, T2, and T3 significantly decreased from the baseline values (T0) in all three groups (P<0.05). The IOP changes between T1 and T2 among three groups were similar (P>0.05). The values of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at T1 and T2 significantly decreased in all three groups compared to T0 (P<0.05).

Conclusion

Bilateral IOP significantly decreased from the baseline values in all three groups during the induction phase. Cisatracurium, rocuronium, and mivacurium did not induce significant changes in bilateral IOP.

Keywords:

• intraocular pressure
• cisatracurium
• rocuronium
• mivacurium
• general anesthesia
• ophthalmic surgery

Acknowledgments

Assistance with the study: none. Financial support and sponsorship: Shanghai Committee of Science and Technology, China (Grant No.16DZ1911108). Presentation: none.

Data Sharing Statement

We are willing to share all relevant data in this study. After the article is published, readers can contact the corresponding author to obtain data by email. The study protocol, statistical analysis plan, and clinical study report will also be available.

Disclosure

The authors report no conflicts of interest in this work.