Chaurasia Shweta, Soni Shiv Lal, Ganesh Venkata, Ram Jagat, Sukhija Jaspreet, Chaurasia Swati, Takkar Aastha
Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Anaesthesiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Front Med (Lausanne). 2023 Jun 15;10:1029952. doi: 10.3389/fmed.2023.1029952. eCollection 2023.
To analyze the relationship between eccentric downward eye movement/eccentric downward eye-positioning (EDEM/EDEP) encountered in patients undergoing ophthalmic surgeries and its return to a centralized position under general anesthesia (GA) with the depth of anesthesia (DOA).
Patients undergoing ophthalmic surgeries (6 months-12 years) under sevoflurane anesthesia without non-depolarizing muscle relaxant (NDMR) who witnessed a sudden tonic EDEM/EDEP were both retrospectively (R-group) and prospectively (P-group) enrolled (ambispective study). R-group included data-points after induction (AI) till the time surgery lasted while P-group compiled data both during induction (DI) and AI. DOA in terms of MAC (minimum alveolar concentration) at the time of EDEM/EDEP and centralization of eyeball and their timings were noted and compared for both AI and DI data-points. Also, vertical eccentric eye positions were scored and correlated with MAC.
AI data included 22 (14R+8P) events and their mean MAC of EDEM/EDEP and centralization were 1.60 ± 0.25 and 1.18 ± 0.17 respectively ( = 0.000). DI data included 62 (P) cases and its mean MAC of EDEM/EDEP and centralization was 2.19 ± 0.43 and 1.39 ± 0.26 respectively ( = 0.000). Median (IQR) eye positions during down-positioning in 84 events was -3 (-3.9 to -2.5). It was preceded by an eccentric upward drift of eyes in 10/22 (6R+4P) AI cases. A strong negative correlation was seen between DOA and eccentric eye positions ( = -0.77, = 0.000).
Tonic down-rolling of eyes is not uncommon in children seen without NDMR with higher depths of sevoflurane anesthesia compared to point of centralization and fluctuations in DOA should be avoided to circumvent inadvertent complications during ocular surgery.
分析眼科手术患者出现的偏心向下眼动/偏心向下眼定位（EDEM/EDEP）及其在全身麻醉（GA）下恢复到中心位置与麻醉深度（DOA）之间的关系。
在无非去极化肌松药（NDMR）的情况下接受七氟醚麻醉的眼科手术患者（6个月至12岁），若出现突然的强直性EDEM/EDEP，则进行回顾性（R组）和前瞻性（P组）纳入（双向研究）。R组包括诱导后（AI）至手术持续期间的数据点，而P组收集诱导期间（DI）和AI期间的数据。记录EDEM/EDEP和眼球中心化时以最低肺泡浓度（MAC）表示的DOA及其时间，并对AI和DI数据点进行比较。此外，对垂直偏心眼位进行评分并与MAC相关联。
AI数据包括22例（14例R组+8例P组）事件，其EDEM/EDEP和中心化的平均MAC分别为1.60±0.25和1.18±0.17（P = 0.000）。DI数据包括62例（P组）病例，其EDEM/EDEP和中心化的平均MAC分别为2.19±0.43和1.39±0.26（P = 0.000）。84例事件中向下定位期间的中位（四分位间距）眼位为-3（-3.9至-2.5）。在10/22例（6例R组+4例P组）AI病例中，其之前有眼球偏心向上漂移。DOA与偏心眼位之间存在强负相关（r = -0.77，P = 0.000）。
在无NDMR的儿童中，与中心化点相比，七氟醚麻醉深度较高时眼球强直性下转并不少见，应避免DOA波动以避免眼科手术期间的意外并发症。
