Phanphruk Warachaya, Alkharashi Maan, Bilge Aykut, Hunter David G
Ophthalmology Department, Boston Children's Hospital, Boston, Massachusetts; Ophthalmology Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Ophthalmology Department, Boston Children's Hospital, Boston, Massachusetts; Ophthalmology Department, Harvard Medical School, Boston, Massachusetts; Ophthalmology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
J AAPOS. 2017 Jun;21(3):196-200. doi: 10.1016/j.jaapos.2017.05.010. Epub 2017 May 19.
To study methods and adverse events of postoperative, sedated suture adjustment after strabismus surgery in the post-anesthesia care unit (PACU).
We reviewed the postoperative experience of all children ≤18 years of age undergoing adjustable suture strabismus surgery at Boston Children's Hospital over a 3-year period. Time in the hospital, adverse events, and surgical outcomes were reviewed to evaluate safety and healthcare resource utilization.
Of 356 patients, 113 required suture adjustment in the PACU, including 24 adjusted while awake and 89 adjusted under sedation. For sedation, sequential boluses of propofol were administered until adjustment was complete. Complete data from the sedated adjustment was available in 76 patients. The median initial bolus was 30 mg; the median total propofol rate was 273 mcg/kg/min. Twelve patients (16%) required only a single bolus of propofol. Of remaining 64 patients, median time from initial to final propofol dose was 7 minutes. Median anesthesiologist time in the PACU was 13 minutes. In the sedated adjustment group, there were no clinically significant adverse events, and the pain score never exceeded 6 (of a possible 10). Median duration of PACU stay was shortest in the group not requiring adjustment.
Sedated suture adjustment allows for fine-tuning of postoperative binocular alignment in children and uncooperative adults. No adverse events were observed in our study group, but the procedure does increase the time patients spend in the hospital. This work will inform disclosure of risks and benefits of sedated adjustment while allowing for more accurate assessment of the cost and quality of adjustable sutures in children.
研究在麻醉后监护病房（PACU）进行斜视手术后镇静状态下缝线调整的方法及不良事件。
我们回顾了波士顿儿童医院3年内所有18岁及以下接受可调缝线斜视手术患儿的术后情况。对住院时间、不良事件和手术结果进行了回顾，以评估安全性和医疗资源利用情况。
356例患者中，113例在PACU需要进行缝线调整，其中24例在清醒状态下调整，89例在镇静状态下调整。对于镇静，逐次推注丙泊酚，直至调整完成。76例患者有镇静调整的完整数据。初始推注的中位数为30mg；丙泊酚总给药速率的中位数为273mcg/kg/min。12例患者（16%）仅需单次推注丙泊酚。其余64例患者中，从首次到最后一次丙泊酚给药的中位时间为7分钟。麻醉医生在PACU的中位时间为13分钟。在镇静调整组中，未出现具有临床意义的不良事件，疼痛评分从未超过6分（满分10分）。不需要调整的组在PACU的中位停留时间最短。
镇静状态下的缝线调整可对儿童和不合作的成人术后双眼视轴对准进行微调。我们的研究组未观察到不良事件，但该操作确实增加了患者的住院时间。这项工作将为镇静调整的风险和益处的披露提供信息，同时有助于更准确地评估儿童可调缝线的成本和质量。
