Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Harrad, R A; Stoddart, Peter

doi:10.1038/sj.eye.6702487

Cited by 5 publications

(7 citation statements)

References 4 publications

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“…Further physiologic studies using electromyography to assess the superior rectus and inferior rectus muscles during anesthesia may help resolve this issue. Harrad and Stoddart [ 19 ] suggested that Bell's phenomenon may explain this eccentric eye position. However, the protection afforded by Bell's phenomenon is significantly decreased during general anesthesia [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

Kook

Chung

Park

et al. 2018

Korean J Ophthalmol

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PurposeTo assess the relationship between eye position and anesthesia depth using the bispectral index (BIS) value, a parameter derived from electroencephalography data.MethodsWe investigated the relationship between BIS value and eye position in 32 children who underwent surgery for epiblepharon under general anesthesia. BIS values were recorded continuously throughout the procedure (from induction to awakening). Eye positions were video-recorded and analyzed after surgery. The vertical position of each eye was scored according to its height in relation to the medial canthus. An eye position in which the upper eyelid covered one-third of the cornea was defined as a significant ocular elevation.ResultsThe BIS value correlated inversely with the end-tidal concentration of each anesthetic agent, whereas it correlated positively with the eye elevation score (eye position = 0.014 × BIS + 0.699, p = 0.011). The mean eye position score was significantly greater in patients whose BIS values were over 65. Eleven patients (34.4%) had significant ocular elevation; their mean concurrent BIS value was 61.6. Two of these patients had elevation during surgery and 9 had elevation during emergence from anesthesia.ConclusionsWe found that high BIS values were correlated with low levels of anesthetic concentration and high eye position, suggesting that BIS monitoring may be useful for predicting eye position during anesthesia. Particular attention must be given to eye position during ophthalmic surgery. Anesthesia depth can be maintained by assuring that the BIS value remains below 65.

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Section: Discussionmentioning

confidence: 99%

Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

Kook

Chung

Park

et al. 2018

Korean J Ophthalmol

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“…Rossiter et al reasoned intense and sustained contraction of superior rectus (SR) behind the eccentric upward eye position. 5 Harrad and Stoddart 17 suggested that Bell's phenomenon, a natural protective re ex, in which the globe rolls up in response to any noxious stimuli in the form of pressure on the globe or any manipulation of the eyeball may explain this upward eccentric eye position. 18,19 This occurs both in the awake state and with lighter planes of anaesthesia (though the patient is not awake) which may explain the entity.…”

Section: Discussionmentioning

confidence: 99%

“…20 Bell's re ex is also extinguished with deep planes of anaesthesia such that the eye remains in the neutral gaze. 16,17 And this upward drift in cases 2, 3, and 4 prompted the anesthetist to increase the depth of anesthesia to make the eyes return from the upward position following which down-rolling was encountered.…”

Section: Discussionmentioning

confidence: 99%

Tonic Downward Movement of Eyes and Its Eccentric Positioning in Downgaze Under General Anaesthesia 

Chaurasia

Soni

Ram

et al. 2021

Preprint

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Objectives. To summarize abrupt eccentric eye positioning in downgaze following the downward movement of eyes encountered in patients undergoing ophthalmic surgeries under general anesthesia (GA) and analyze the relationship between the fluctuation in the depth of anesthesia (DOA) and eccentric eye positioning in downgaze. Subjects and Methods. Patients undergoing ophthalmic surgeries under GA without nondepolarizing muscle relaxant between January 2018-December 2019 in a tertiary-eye-care who witnessed a sudden tonic hypo-tropic movement of eyes were included in the retrospective, cross-sectional study. Results. A total of 8 patients out of 199 were enrolled in this study with an average age of 1.13±0.40years. All cases (3 pediatric cataracts, 4 strabismus, and 1 pseudophakia with posterior capsular opacification) were performed under GA with sevoflurane as an inducing agent. Downward movement was seen before the start of surgery in 4 cases and during surgery in 4 cases. Downward drift of eyes appeared tonic as the strong tug was felt in an extreme downward eccentric position. It was preceded by an eccentric upward drift of eyes following which sevoflurane concentration was increased to optimize DOA when this downward drift was encountered (mean minimal alveolar concentration/MAC 1.63±0.25). Downward movement was quick but return movement of eyes to the central position was gradual (mean 1.55±0.48minutes) when DOA was decreased (mean MAC 1.3±0.09).Conclusions. Tonic-downward movement of eyes or its eccentric positioning in downgaze is not an uncommon entity in children under GA without muscle-relaxant and fluctuations in DOA should be avoided to circumvent inadvertent complications during ocular surgery.

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“…In contrast to small animal species, in which stage 3 of general anesthesia is associated with a high incidence of ventral globe deviation, in human beings the incidence of eccentric eye positioning during general anesthesia is very low . Thus, many intraocular surgeries in humans can be easily performed without using non‐depolarizing muscle relaxants (NDMR) for globe positioning.…”

Section: Discussionmentioning

confidence: 99%

Phacoemulsification considerations in nonhuman primates

Leiva

Peña

Bayón

et al. 2012

J of Medical Primatology

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Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Cited by 5 publications

References 4 publications

Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

Tonic Downward Movement of Eyes and Its Eccentric Positioning in Downgaze Under General Anaesthesia

Phacoemulsification considerations in nonhuman primates

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Operating conditions for ocular surgery under general anaesthesia: an eccentric problem

Cited by 5 publications

References 4 publications

Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

Use of the Bispectral Index to Predict Eye Position of Children during General Anesthesia

Tonic Downward Movement of Eyes and Its Eccentric Positioning in Downgaze Under General Anaesthesia&nbsp;

Phacoemulsification considerations in nonhuman primates

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Tonic Downward Movement of Eyes and Its Eccentric Positioning in Downgaze Under General Anaesthesia