使用丙泊酚和琥珀酰胆碱的电休克疗法对眼压的影响。

The effect of electroconvulsive therapy using propofol and succinylcholine on the intraocular pressure.

作者信息

Boroojeny Shahram Borjian, Tabatabai Nargess Hosseini, Babakhani Babak, Babakhani Siamak, Moody Zahra

机构信息

Zahedan University of Medical Sciences, Medical School, Department of Anesthesiology, Zahedan, Iran.

出版信息

Middle East J Anaesthesiol. 2012 Jun;21(5):713-7.

PMID:23265035

Abstract

PURPOSE

Electroconvulsive therapy (ECT) is a therapeutic procedure in many mood and psychiatric disorders. After induction of general anesthesia by administering an induction dose of an intravenous anesthetic such as Propofol, intravenous succinylcholine is often used to prevent bone fractures and joint dislocations during ECT. Intraocular pressure (IOP) is raised by succinylcholine and tonic-colonic convulsion,and decreased by propofol administration. To our knowledge, there is no published paper on the effect of ECT using propofol and succinylcholine on the IOP. This study for the first time shows the effect of ECT on IOP. The source of the financial support is a grant allocation of Zahedan University of Medical Sciences. There is no financial relationship between authors and commercial interest with a vested interest in the outcome of the study.

METHODS

One hundred patients 20 to 40 years old ASA class 1 or 2 without any ophthalmic disorders were enrolled. All of the psychiatric medications were discontinued 48 hours before ECT treatment. The baseline IOP values of the patients were checked after application of sterile eye drop tetracaine 0.5% by an applanation tonometer, and then the patients received atropine 0.5 mg, propofol 0.75 mg/kg, succinylcholine 1 mg/kg intravenously, with intervals of 1 minute. Then electrical stimulation was delivered via bi-frontal electrodes. IOPs were checked before any drug administration, before electrical application, as well as 1, 5 and 10 minutes after termination of the convulsion.

RESULTS

The baseline IOP (14.81 +/- 3.6 mmHg) decreased significantly after administration of propofol (13.18 +/- 3.55 mmHg) but increased significantly after succinylcholine (15.52 +/- 3.58 mmHg), one minute (18.32 +/- 3.49 mmHg) and 5 minutes after convulsion (15.41 +/- 3.46 mmHg). However, IOP returned to the baseline 10 minutes after convulsion (14.68 +/- 3.57 mmHg).

CONCLUSION

IOP increased after ECT but the IOP levels never reached to pathologic range in this study. Therefore, regarding IOP, ECT is a safe procedure in patients with normal eye condition. Further studies are recommended in older patients with ophthalmic diseases.

摘要

目的

电休克疗法（ECT）是治疗多种情绪和精神障碍的一种治疗手段。在通过静脉注射丙泊酚等诱导剂量的静脉麻醉药诱导全身麻醉后，静脉注射琥珀酰胆碱常用于预防ECT期间的骨折和关节脱位。琥珀酰胆碱会升高眼压（IOP）并引发强直性结肠痉挛，而丙泊酚给药会降低眼压。据我们所知，尚无关于使用丙泊酚和琥珀酰胆碱进行ECT对眼压影响的发表论文。本研究首次展示了ECT对眼压的影响。资金支持来源是扎黑丹医科大学的拨款。作者与对研究结果有既得利益的商业利益方之间不存在财务关系。

方法

纳入100例年龄在20至40岁、ASA分级为1或2级且无任何眼科疾病的患者。所有精神科药物在ECT治疗前48小时停用。在使用0.5%无菌丁卡因滴眼液后，用压平眼压计检查患者的基线眼压值，然后患者静脉注射0.5毫克阿托品、0.75毫克/千克丙泊酚、1毫克/千克琥珀酰胆碱，间隔1分钟。然后通过双额电极进行电刺激。在任何药物给药前、电刺激前以及惊厥终止后1、5和10分钟检查眼压。

结果

丙泊酚给药后基线眼压（14.81±3.6 mmHg）显著降低（13.18±3.55 mmHg），但琥珀酰胆碱给药后显著升高（15.52±3.58 mmHg），惊厥后1分钟（18.32±3.49 mmHg）和5分钟（15.41±3.46 mmHg）。然而，惊厥后10分钟眼压恢复到基线（14.68±3.57 mmHg）。