Immobilization during anesthesia for vitrectomy using a laryngeal mask without neuromuscular blockade versus endotracheal intubation and neuromuscular blockade

Fudickar, Axel; Gruenewald, Matthias; Fudickar, Beate; Hill, Moritz; Wallenfang, Martin; Hüllemann, Julia; Voss, Dana; Caliebe, Amke; Roider, Johann; Steinfath, Markus; Treumer, Felix

doi:10.23736/s0375-9393.17.12282-0

Cited by 4 publications

(5 citation statements)

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“…16 Similarly, in another study done in adults, using laryngeal mask without neuromuscular blockade was associated with an increased incidence of upward eye deviations during anesthesia in comparison with intubation; no clinically relevant difference was revealed in quality of eye immobilization between groups. 2 In the current study, eccentric eye elevation had occurred more frequently with concurrent elevation of BIS values during surgery. However, it cannot explain why patients with similar BIS values had significant differences in ocular deviation.…”

Section: Discussionmentioning

confidence: 41%

“…A Priori G-power analysis was done to estimate the study sample size which was based on previous study. 2 Assuming α (type 1 error) = 0,05 and β (type 2 error) = 0,2 (power =80 %), 46 patients per group were sufficient to detect a 20% difference of incidence in eye movements among the groups. A drop out of 10% of cases were expected.…”

Section: Discussionmentioning

confidence: 98%

“…If anesthesia is adopted to BIS, the concentration of volatile anesthetics may be lowered to the MAC-awake and below MAC, thus jeopardizing immobilization. 2 Asynchronous events were accompanied by a transient increase in BIS values which required an increase in sevoflurane concentration to keep BIS value at 40-60. 18 According to the present study, spontaneous mode of ventilation seemed to make more consumption of sevoflurane than controlled mode to achieve adequate depth of anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…The goals of anesthetic management in pediatric cataract surgery are to provide an immobile operative field without an increase in intra-ocular pressure (IOP), and to maintain a hemodynamically stable child, adequate depth of anesthesia with less anesthetic consumption and a low incidence of peri-operative complications. [1][2] Intra-operative awareness during anesthesia in children can have long-term behavioral and psychological effects. 3 The bispectral index (BIS) is considered a good general measure of the depth of anesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Impact of spontaneous vs. controlled ventilation with laryngeal mask airway in pediatric cataract surgery

Elsherbiny¹,

EL-Deeb²,

Gaafar³

et al. 2022

Anaesth. pain intensive care

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Background & objectiveː Anesthetic management of pediatric cataract surgery is special as most of these surgeries have to be completed under general anesthesia, and airway management and adequate ventilation take precedence and special care. We compared spontaneous ventilation vs. controlled ventilation, using laryngeal mask airway (LMA) with or without muscle relaxation showing their impact on different parameters in pediatric cataract surgery. Methodology: This prospective study included 150 ASA-I and II children, who underwent elective cataract surgery. The patients were randomly divided into three groups: Group-A, B and C to receive spontaneous ventilation, unparalyzed controlled and paralyzed controlled ventilation through LMA, respectively. Evaluation of the effect of ventilation on position of the eyes during surgery in relation to depth of anesthesia, intra-ocular pressure (IOP), surgeon’s satisfaction, consumption of sevoflurane, emergence agitation, respiratory parameters and intra-operative hemodynamic stability were the main outcome measures registered. Resultsː Pressure-controlled ventilation using laryngeal mask improved dynamic compliance with statistically significant lower incidence of eye movements (p = 0.001) and lower IOP measurements despite decreased sevoflurane consumption and higher BIS values (p < 0.001). It led to better surgeon satisfaction and less postoperative agitation (p < 0.001) without any statistically significant differences in hemodynamic parameters or EtCO2, in comparison to spontaneous ventilation. Conclusionː Pressure-controlled ventilation through laryngeal mask airway with low-dose muscle relaxants and titrated anesthesia under bispectral index monitoring is an acceptable safe clinical practice. However, ventilation without neuromuscular blockade could be an alternative with adequate monitoring. Abbreviations: LMA – laryngeal mask airway; EtCO2 – End-tidal carbon dioxide level; BIS – Bispectral index; IOP – Intra-ocular pressure; Key words: Ventilation; Laryngeal Mask Airway; Eye Movement; Positive-Pressure Respiration; Child; Humans; Lens Capsule, Crystalline / surgery; Pediatrics / methods Citation: El-Sherbiny SM, EL-Deeb AH, Gaafar WM, Ismail OM, Messeha MM. Impact of spontaneous vs. controlled ventilation with laryngeal mask airway in pediatric cataract surgery. Anaesth. pain intensive care 2022;26(3):360-367. DOI: 10.35975/apic.v26i3.1911 Received: September 06, 2021, Reviewed: April 21, 2022, Accepted: May 01, 2022

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of spontaneous vs. controlled ventilation with laryngeal mask airway in pediatric cataract surgery

Elsherbiny¹,

EL-Deeb²,

Gaafar³

et al. 2022

Anaesth. pain intensive care

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“…When opioids are incorporated into the anesthesia protocol, MAC values should be adjusted to 0.8-1.0 in accordance with vital parameters. [48] In our daily medical practice, we administer a neuromuscular blocker at a dosage of 0.3 mg/kg to patients who are fitted with a laryngeal mask. This effectively prevents patient movement during the procedure.…”

Section: General Anesthesia Applicationsmentioning

confidence: 99%

Anesthesia for ophthalmic surgery

Sahutoglu

2024

Eur Eye Res

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Local and regional anesthesia are commonly employed methods in eye surgery, there are situations in which general anesthesia becomes necessary. Some patients may decline local or regional anesthesia, be unable to maintain a steady position, or lie flat during the procedure. This is particularly pertinent for pediatric patients and individuals with allergies to local anesthetics, who may require general anesthesia. In all cases, meticulous patient preparation is paramount in eye surgery. A thorough evaluation is essential before administering anesthesia, with the choice of anesthesia method dependent on factors such as the patient's overall health, the specific surgical procedure, and the surgeon's expertise. In this review, necessary anesthesia methods in ophthalmic surgeries and perioperative patient management will be discussed.

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