Influence of head flexion after endotracheal intubation on intraocular pressure and cardio-respiratory response in patients undergoing cataract surgery

Abstract

During preparation and draping of periorbital area, neck flexion causes displacement of the endotracheal tube tip toward the carina. Stimulation of the tracheal mucosa may cause bucking, increased intraocular pressure (IOP), laryngospasm, bronchospasm, change in end-tidal carbon dioxide pressure (PETCO2) or peripheral arterial haemoglobin oxygen saturation (SpaO2) during light anaesthesia. To investigate the influence of head and neck flexion after endotracheal intubation on heart rate (HR), systolic and diastolic blood pressure (SAP and DAP), SpaO2, PETCO2 and IOP in patients undergoing cataract surgery during general anesthesia. In this prospective observational study, 106 ASA physical status I and II patients scheduled for elective cataract surgery under general anaesthesia were studied. Anaesthesia was induced with thiopental sodium, lidocaine and fentanyl. Atracurium 0.5 mg/kg was given to facilitate tracheal intubation. HR, SAP, DAP, SpaO2, PETCO2, and IOP were measured at 1, 2, and 5 minutes after head flexion. Mean SAP, DAP, IOP, and HR were significantly increased after head flexion compared with baseline values (P < 0.05). PETCO2 and SpaO2 were significantly decreased at 1 and 2 minutes after head flexion compared with baseline values (P < 0.001). It is concluded that endotracheal tube movement by changes in head and neck position has significant effects on heart rate, systolic and diastolic blood pressures, laryngeal reflexes, SpaO2, PETCO2, and intraocular pressure in patients undergoing cataract surgery under general anaesthesia.