Comparison of sugammadex and neostigmine-atropine on intraocular pressure and postoperative effects

Abstract

During surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18-65 years, with a risk status of the American Society of Anesthesiologists I-II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 μg/kg) plus atropine (15 μg/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine-atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine-atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group (p = 0.003) than in the neostigmine-atropine group.

Keywords: Extubation; Intraocular pressure; Neostigmine; Sugammadex.

Figure 1

Mean arterial pressure at each time interval from baseline to 30 minutes after tracheal extubation. Bars represent standard deviation. α = p < 0.05 compared with baseline value.

Figure 2

Heart rate at each time interval from baseline to 30 minutes after tracheal extubation. Bars represent standard deviation. α = p < 0.05 compared with baseline value. β = p < 0.05 compared with the sugammadex group.

Figure 3

Intraocular pressure at each time interval from baseline to 30 minutes after extubation. Bars represent standard deviation. α = p < 0.05 compared with baseline value.