How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia

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dc.contributor.advisorRoodt, Francoisen_ZA
dc.contributor.authorVan der Walt, Jessica Gwendolineen_ZA
dc.date.accessioned2016-02-09T12:16:07Z
dc.date.available2016-02-09T12:16:07Z
dc.date.issued2015en_ZA
dc.descriptionIncludes bibliographical referencesen_ZA
dc.description.abstractPurpose: 1.To determine the effect of sevoflurane induction, followed by intravenous (IV) ketamine infusion on intraocular pressure (IOP) in the paediatric glaucoma population. 2. To establish the earliest time point at which IOP measurement most closely resembles awake values. Methods: A prospective, descriptive study of the IOP changes occurring in 25 children requiring IOP measurements at our institution. A standardised anaesthetic technique was employed; sevoflurane induction, intravenous cannulation, ketamine bolus (2mg/kg) and maintenance (4mg/kg/hr) for 15 minutes. IOP measurements and physiological variables were recorded after sevoflurane induction, then every 2 minutes for a period of 10 minutes, one at 15 minutes as well as 5 minutes after ketamine discontinuation. Results: IOP was measured in 25 patients (50 eyes). Twenty-six eyes (52%) had glaucoma. The mean patient age was 29 months (range 2-88 months). The mean IOP after sevoflurane induction was 3,68mmHg lower than that with ketamine maintenance (sevoflurane eliminated) (95% CI 1,35 to 6,02mmHg) (p=0,002)). Physiological variables return to baseline at 8 minutes, which correlates with the time taken for sevoflurane to be eliminated from exhaled gas. The difference in IOP between ketamine anaesthesia (time 15 minutes) and near wakefulness was only 0,28 mmHg (95% CI -2,23 to 2,79mmHg) (p=0,826). Mixed effects models showed similar trends but a higher baseline (7,85mmHg (6,19 to 9,51mmHg) (p<0,001)) in those with glaucoma when compared to those without. Conclusion: Sevoflurane lowers IOP significantly when compared to ketamine anaesthesia. While eyes with glaucoma had a higher baseline than those which did not have glaucoma, both groups follow similar trends in response to the anaesthetic agents. This standardised anaesthetic protocol allows reliable IOP measurement 15 minutes after termination of sevoflurane and commencement of ketamine infusion, with no reported adverse events.en_ZA
dc.identifier.apacitationVan der Walt, J. G. (2015). <i>How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia. Retrieved from http://hdl.handle.net/11427/16931en_ZA
dc.identifier.chicagocitationVan der Walt, Jessica Gwendoline. <i>"How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2015. http://hdl.handle.net/11427/16931en_ZA
dc.identifier.citationVan der Walt, J. 2015. How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Van der Walt, Jessica Gwendoline AB - Purpose: 1.To determine the effect of sevoflurane induction, followed by intravenous (IV) ketamine infusion on intraocular pressure (IOP) in the paediatric glaucoma population. 2. To establish the earliest time point at which IOP measurement most closely resembles awake values. Methods: A prospective, descriptive study of the IOP changes occurring in 25 children requiring IOP measurements at our institution. A standardised anaesthetic technique was employed; sevoflurane induction, intravenous cannulation, ketamine bolus (2mg/kg) and maintenance (4mg/kg/hr) for 15 minutes. IOP measurements and physiological variables were recorded after sevoflurane induction, then every 2 minutes for a period of 10 minutes, one at 15 minutes as well as 5 minutes after ketamine discontinuation. Results: IOP was measured in 25 patients (50 eyes). Twenty-six eyes (52%) had glaucoma. The mean patient age was 29 months (range 2-88 months). The mean IOP after sevoflurane induction was 3,68mmHg lower than that with ketamine maintenance (sevoflurane eliminated) (95% CI 1,35 to 6,02mmHg) (p=0,002)). Physiological variables return to baseline at 8 minutes, which correlates with the time taken for sevoflurane to be eliminated from exhaled gas. The difference in IOP between ketamine anaesthesia (time 15 minutes) and near wakefulness was only 0,28 mmHg (95% CI -2,23 to 2,79mmHg) (p=0,826). Mixed effects models showed similar trends but a higher baseline (7,85mmHg (6,19 to 9,51mmHg) (p<0,001)) in those with glaucoma when compared to those without. Conclusion: Sevoflurane lowers IOP significantly when compared to ketamine anaesthesia. While eyes with glaucoma had a higher baseline than those which did not have glaucoma, both groups follow similar trends in response to the anaesthetic agents. This standardised anaesthetic protocol allows reliable IOP measurement 15 minutes after termination of sevoflurane and commencement of ketamine infusion, with no reported adverse events. DA - 2015 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia TI - How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia UR - http://hdl.handle.net/11427/16931 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16931
dc.identifier.vancouvercitationVan der Walt JG. How does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesia. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2015 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/16931en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Anaesthesiaen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherAnaesthesiologyen_ZA
dc.titleHow does sevuflurane induction, followed by a ketamine maintenance infusion affect intraocular pressure? : establishment of a protocol for paediatric glaucoma examinations under anaesthesiaen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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