Succinylcholine Alteration of the Forced Duction Test

France, Nancy Knutsen; France, Thomas D.; Woodburn, James; Burbank, Daniel P.

doi:10.1016/s0161-6420(80)35094-x

Cited by 43 publications

(6 citation statements)

References 4 publications

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“…Unlike previous studies [15], we did not used neuromuscular blocking agents considering that they act directly on muscle tone leading to a flaccid paralysis, and that succinylcholine induces an unpredictable contraction of the extraocular muscles after about 30 seconds from intravenous injection for at least 10 minutes [18,24]. The inhalational anesthetics used for induction and maintenance of general anesthesia (such as sevoflurane) eliminate the active muscle tone, which includes the so-called esotonus, without inducing any other muscle contraction.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2019

OCR

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Purpose: To study the different trends of eye position changes under narcosis in Infantile Intermittent Exotropia (IXT) compared to Infantile Esotropia (ET). To discuss the possible causes of the difference.Methods: Twenty-nine patients, aged 2 to 15 years, undergoing surgery for infantile concomitant strabismus at University Eye Clinic of Bologna, between January 2017 and December 2019, took part in this prospective study. Of them, 13 had basic or simulated divergence excess IXT and 16 had ET. Eye position was measured preoperatively and under general anesthesia with a modified Paliaga Test for the measure of interlimbal distance (ILD). In IXT patients the prolonged occlusion test was performed preoperatively. Neuromuscular blocking agents were not used to induce general anaesthesia. Results:In IXT patients the difference between preoperative and intraoperative ILD was not statistically significant (Wilcoxon, p>0.05), and showed a great variability, as under narcosis ILD decreased in 38.46%, did not change in 30.77%, and increased in 30.77% of patients; while in ET patients it increased under narcosis, with a statistical significance (Wilcoxon, p=0.002). Conclusion:Differences in the determinants of the ocular deviation may be suspected in ET and IXT, particularly regarding the role of esotonus, that is the baseline innervation to the extraocular muscles which opposes the position of rest in the awake state and which is suppressed under narcosis. While esotonus is increased in ET, it could be even decreased in IXT where other innervational phenomena, like active divergence, may be involved in determining the deviation.

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Section: Discussionmentioning

confidence: 99%

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2019

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“…Suxamethonium causes a sustained contraction of the extraocular muscles for up to 20 minutes and therefore interferes with the interpretation of the forced duction test. 61 The mechanism of this prolonged effect of suxamethonium on the extraocular muscles compared with other peripheral skeletal muscles is unclear. When suxamethonium is used, the forced duction test should be delayed for about 20 minutes after its injection so that its effects on the extraocular muscles have dissipated.…”

Section: Anaesthetic Considerationsmentioning

confidence: 99%

Anaesthetic considerations for strabismus surgery in children and adults

Chua

Leung

et al. 2020

Anaesth Intensive Care

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Strabismus correction surgery is the most common eye operation in children. Adults have approximately a 4% lifetime risk of developing strabismus. Current treatment options include pharmacological injection of botulinum toxin or bupivacaine, conventional corrective surgery, adjustable suture surgery and minimally invasive surgery. Repeated surgery is common as each operation has a 60%–80% chance of successful correction. The benefits of early surgical correction in large-angle strabismus in children outweigh the risks of anaesthesia. General anaesthesia is suitable for patients of all age groups, for complicated or repeated surgery, and bilateral eye procedures. Regional ophthalmic block reduces the incidence of oculocardiac reflex and emergence agitation, and provides postoperative analgesia, but requires a cooperative patient as many experience discomfort. Topical anaesthesia has been used in pharmacological injection, minimally invasive surgery, uncomplicated conventional strabismus surgery and some adjustable suture strabismus surgery. Its use, however, is only limited to cooperative adult patients. Prophylactic antiemesis with both ondansetron and dexamethasone is recommended, especially for children. A multimodal analgesia approach, including paracetamol, intravenous non-steroidal anti-inflammatory drugs, topical local anaesthetic and minimal opioid usage, is recommended for postoperative analgesia, while a supplementary regional ophthalmic block is at the discretion of the team.

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“…17,35 A non-depolarising muscle relaxant is preferred over suxamethonium, if required, as it does not interfere with forced duction tests. 46 The Difficult Airway Society, the British Association of Oral and Maxillofacial Surgery and the British Association of Otorhinolaryngology, Head and Neck Surgery in their consensus statement no longer recommend the routine insertion of a throat pack (e.g. for transnasal endoscopic surgery) by the anaesthetist, as in a systematic review there was no supportive evidence of its benefit yet many documented complications, including severe postoperative airway obstruction and death.…”

Section: Choice Of Anaesthetic Techniquesmentioning

confidence: 99%

Anaesthesia for ophthalmic procedures in patients with thyroid eye disease

Chua

Kumar

Chua

et al. 2020

Anaesth Intensive Care

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Thyroid eye disease is an autoimmune inflammatory disorder of the orbit in adults. It causes inflammation, expansion and fibrosis of orbital fat, muscles and the lacrimal gland, leading to facial disfigurement, functional disability and, in severe cases, blindness. Overall, approximately 20% of affected patients need some form of surgical intervention requiring anaesthesia. This narrative review explores the background of thyroid eye disease, surgical procedures performed and their implications for anaesthesia. General anaesthesia is used for orbital decompression procedures, strabismus correction surgery and complex oculoplastic procedures. Local anaesthetic infiltration or regional anaesthesia under monitored anaesthesia care are the techniques most commonly employed for eyelid retraction surgery. It is important to limit the volume of local anaesthetic agent used during infiltration and continuously monitor the orbital volume and ocular pressure with a ballottement technique. In addition, the contralateral eye should be checked and, if necessary, protected against corneal exposure. Retrobulbar, peribulbar and sub-Tenon’s blocks are best avoided. Topical anaesthesia has been used for some strabismus correction surgery but its use is limited to motivated and cooperative patients only.

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Succinylcholine Alteration of the Forced Duction Test

Cited by 43 publications

References 4 publications

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Anaesthetic considerations for strabismus surgery in children and adults

Anaesthesia for ophthalmic procedures in patients with thyroid eye disease

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