Dexmedetomidine-based monitored conscious sedation combined local anesthesia for levator resection in a 10-year-old child with Marcus Gunn jaw-winking synkinesis

Abstract

Rationale:Levator resection has become a routine procedure for patients with severe Marcus Gunn jaw-winking synkinesis (MGJWS). To optimize the surgical outcome, adult patients need to be kept awake, or easily aroused and responsive to verbal commands during the operation. However, levator resection is commonly performed under general anesthesia in pediatric patients. In the present case, we described a successful anesthetic protocol of conscious sedation with local anesthesia for levator resection in a child.Patient concerns:A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The patient was born through a normal delivery and had no previous history of allergy, no comorbidity, and no history of receiving anesthesia or operation. The laboratory tests of the patient were unremarkable.Diagnoses:The diagnosis of MGJWS was made by two experienced ophthalmologists.Interventions:A 10-year-old boy with MGJWS was admitted to our hospital and scheduled for levator resection. The levator resection was performed under monitored conscious sedation with dexmedetomidine and local anesthesia.Outcomes:Patient with spontaneous breathing responded normally to verbal commands throughout the operation, and no adverse events occurred. The patient and ophthalmologist reported high satisfaction with anesthesia management.Lessons:Dexmedetomidine-based monitored conscious sedation with local anesthesia is a feasible alternative to general anesthesia for levator resection in collaborative patients.

Effectiveness Comparison of Dexmedetomidine and Remifentanil for Perioperative Management in Patients Undergoing Endoscopic Sinus Surgery

“…In addition, it can provide antianxiety, sedative, analgesic, and narcotic-sparing effects. 9 Remifentanil is a specific mu-type-opioid receptor agonist that has a rapid onset and rapid recovery time and reduces sympathetic nervous system tone. It can produce a dose-dependent analgesic effect, mild bradycardia, and 15% to 20% decrease in arterial blood pressure.…”

Efficacy of Modified Shortening of Levator Palpebrae Superioris Muscle on Patients with Ptosis

“…Different surgical methods have different advantages and disadvantages [9] . Among all surgical methods for correcting ptosis, correction based on levator palpebrae superioris muscle is more in line with the physiological structure of eyelids [10] , which provides more significant postoperative effect, causes less trauma and contributes to shorter operation time and postoperative recovery time, so it is almost suitable for all mild and moderate ptosis [11] . The main surgical methods based on levator palpebrae superioris muscle include folding aponeurosis of levator palpebrae superioris muscle and shortening of levator palpebrae superioris muscle, which can increase the initial muscle length within a certain range, thus enhancing muscle strength.…”