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.