Open-Globe Eye Injuries and Choice of Muscle Relaxant: A Review of the Evidence

Abstract

A goal of treatment of open-globe eye injuries is preventing rises in intraocular pressure and the resulting loss of vitreous humor fluid from the eye globe. Surgical repair of these injuries often requires general anesthesia and tracheal intubation. Normal intraocular pressure is 10-22 mm Hg, with variations between daytime and nighttime values. Factors such as eye muscle structure, fluid volume in the eye, overall hemodynamic status, blood acidity, and mechanical pressure collectively contribute to fluid pressure within the eye. One factor that has been shown to be strongly correlated with increased intraocular pressure is elevated venous pressure with physiological conditions during tracheal intubation (eg, straining, coughing, bucking). To determine intubation best practices, we reviewed the literature on succinylcholine, a depolarizing neuromuscular blocking agent, and nondepolarizing neuromuscular blocking agents. Research and case reports have not shown an association between the loss of ocular contents and succinylcholine administration. However, succinylcholine has been associated with increased intraocular pressure after administration and intubation. Nondepolarizing neuromuscular blocking agents, particularly rocuronium, administered before or instead of succinylcholine, have been found to attenuate the rise in intraocular pressure after induction and intubation.