Vagal Responses to Adjustable Sutures in Strabismus Correction

Eustis, H. Sprague; Eiswirth, Clement; Smith, David R.

doi:10.1016/s0002-9394(14)71795-7

Cited by 32 publications

(18 citation statements)

References 6 publications

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“…Despite these risks, single-stage adjustable surgery is known to be a safe procedure. 6,[15][16][17][18][19] The success rate of single-stage adjustable surgery is comparable to that observed in previous studies of two-stage adjustment surgery performed under general or retrobulbar anaesthesia. 5,20,21 The primary disadvantages of single-stage adjustable surgery under topical anaesthesia include a longer procedure time and more intraoperative pain and discomfort of the patient.…”

supporting

confidence: 69%

The efficacy of intravenous ketorolac for pain relief in single-stage adjustable strabismus surgery: a prospective, randomized, placebo-controlled trial

Rhiu

Chung

Kim

et al. 2010

Eye

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Purpose To determine the efficacy of preoperative intravenous ketorolac in reducing intraoperative and postoperative pain and improving patient satisfaction in patients undergoing single-stage adjustable strabismus surgery. Methods A prospective, randomized, placebo-controlled clinical trial was performed with 67 patients who underwent horizontal recti muscle surgery with adjustable sutures. The test group received intravenous ketorolac (60 mg) before surgery, and the control group received intravenous normal saline. Topical 0.5% proparacaine was administered to both groups during surgery. Vital signs including heart rate and blood pressure were recorded every 10 min throughout the surgery. The patients were asked to rate their maximum intraoperative and postoperative pain scores using a numerical pain rating scale. Patient satisfaction was also assessed using a five-point analogue scale. Results The ketorolac-premedicated patients had less pain both during and after surgery (P ¼ 0.033 and P ¼ 0.024, respectively). There were no differences in vital signs during surgery and patient satisfaction between the two groups. Conclusions Intravenous ketorolac, when administered preoperatively for single-stage adjustable strabismus surgery under topical anaesthesia, was effective in reducing pain during and after surgery.

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supporting

confidence: 69%

The efficacy of intravenous ketorolac for pain relief in single-stage adjustable strabismus surgery: a prospective, randomized, placebo-controlled trial

Rhiu

Chung

Kim

et al. 2010

Eye

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“…[2] Those studying on oculo-cardiac reflex (OCR), regarded as an old subtype of TCR focusing on the HR only recalled it positive with a 10-20% decline in the HR coincident with the manipulation of the eye-related structures. [251026]…”

Section: Introductionmentioning

confidence: 99%

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Etezadi

Orandi²,

Orandi³

et al. 2013

Surg Neurol Int

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Background:Considering wide variations regarding the incidence of trigeminocardiac reflex (TCR) during cranial neurosurgical procedures, and paucity of reliable data, we intended to design a prospective study to determine the incidence of TCR in patients undergoing standard general anesthesia for surgery of supra/infra-tentorial cranial and skull base lesions.Methods:A total of 190 consecutive patients candidate for elective surgery of supra-tentorial, infra-tentorial, and skull base lesions were enrolled. All the patients were operated in the neurosurgical operating room of a university-affiliated teaching hospital. All surgeries were performed using sufficient depth of anesthesia achieved by titration of propofol–alfentanil mixture, adjusted according to target Cerebral State Index (CSI) values (40-60). All episodes of bradycardia and hypotension indicating the occurrence of TCR during the surgery (sudden decrease of more than 20% from the previous level) were recorded.Results:Four patients, two female and two male, developed episodes of TCR during surgery (4/190; 2.1%). Three patients showed one episode of TCR just at the end of operation when the skin sutures were applied while CSI values were 70-77 and in the last case, when small tumor samples were taken from just beneath the lateral wall of the cavernous sinus TCR episode was seen while the CSI value was 51.Conclusion:TCR is a rare phenomenon during brain surgeries when patient is anesthetized using standard techniques. Keeping the adequate depth of anesthesia using CSI monitoring method may be an advisable strategy during whole period of a neurosurgical procedure.

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“…However, OCR can occur during the adjustment procedure because the adjustment technique allows the surgeon to exert traction on the extraocular muscle [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Adjustment in patients with asystole during strabismus surgery

Min

Hwang

2011

Graefes Arch Clin Exp Ophthalmol

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Purpose To investigate whether patients who developed asystole during strabismus surgery under general anesthesia also develop asystole during adjustment, and whether adjustment can safely be performed under topical anesthesia in these patients. Design Retrospective, noncomparative interventional case series.Methods Adjustment was performed with topical anesthesia in four patients aged 28, 32, 50, and 53 years who exhibited asystole during strabismus surgery under general anesthesia. Blood pressure and electrocardiogram were monitored during the adjustment. Results Adjustment was successfully completed in all patients without asystole. Two patients showed oculocardiac reflex (OCR), with a reduction in heart rate (HR) >20% of the baseline value. One of these patients exhibited severe OCR that developed when the patient's posture was changed from the supine to the sitting position for measurement of the angle of strabismus after adjustment, and again during conjunctival manipulation after conjunctival closure. No patient required atropine. Conclusions Adjustment can safely be performed under topical anesthesia in patients who developed asystole during strabismus surgery under general anesthesia.

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Vagal Responses to Adjustable Sutures in Strabismus Correction

Cited by 32 publications

References 6 publications

The efficacy of intravenous ketorolac for pain relief in single-stage adjustable strabismus surgery: a prospective, randomized, placebo-controlled trial

The efficacy of intravenous ketorolac for pain relief in single-stage adjustable strabismus surgery: a prospective, randomized, placebo-controlled trial

Trigeminocardiac reflex in neurosurgical practice: An observational prospective study

Adjustment in patients with asystole during strabismus surgery

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