Major article
The immediate postoperative adjustment of sutures in strabismus surgery with comaintenance of anesthesia using propofol and midazolam*,☆☆

Presented at the 27th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Orlando, Florida, March 21-25, 2001.
https://doi.org/10.1067/mpa.2002.123398Get rights and content

Abstract

Purpose: Adjustable suture techniques are used to reduce the reoperation rate in strabismus surgery, but traditionally require that final adjustments be made between 1 to 24 hours after surgery. The purpose of this study was to evaluate a new anesthetic technique that would allow immediate postoperative adjustment of sutures in strabismus surgery, thereby improving patient convenience and comfort. Methods: This was a prospective study of strabismus patients who were judged to be appropriate candidates for adjustable sutures. Comaintenance of anesthesia was accomplished using a stepped-down infusion of propofol with midazolam. Final suture adjustments were performed in the operating room immediately upon completion of strabismus surgery. Patient satisfaction was assessed 24 hours later. Patients were followed for 6 weeks postoperatively. Results: A total of 16 patients were studied, with 8 patients having horizontal muscle surgery, 7 patients with vertical muscle surgery, and 1 patient undergoing both horizontal and vertical muscle surgery. The change in deviation after 6 weeks of follow-up was 8 PD or less horizontally in all patients and 4 PD or less vertically in 87% of patients when compared with the alignment in the operating room. Diplopia, if present, resolved in 85% of patients. One patient (6.7%) required a second surgery. The mean drift at 2 weeks horizontally was 1.87 PD esotropic (range, −6 PD exophoric to 18 PD esotropic) and vertically 0.94 PD (range, −4 PD hypotropic to 4 PD hypertropic). The mean drift at 6 weeks horizontally was −0.27 PD exotropic (range, −8 PD exophoric to 8 PD esotropic) and vertically 0.6 PD (range, −6 PD hypotropic to 10 PD hypertropic). Conclusion: The immediate postoperative adjustment of sutures in strabismus surgery may be accurately performed using this new anesthetic technique. (J AAPOS 2002;6:241-5)

Section snippets

Methods

Patients presenting with strabismus and good vision in both eyes, who were judged to be appropriate surgical candidates for adjustable sutures, were invited to enroll in the study. Informed consent was obtained from all patients and the institutional review board of the hospital approved the study.

Results

Sixteen patients ranging in age from 13 to 73 years participated in the study. The ocular alignment abnormalities consisted of pure horizontal (4), pure vertical (4), and combined vertical and horizontal (8) deviations. The ratio of male-to-female participants was 1:1. All patients received the same protocol and had the adjustment done immediately after surgery. One patient in the study was lost to follow-up before the 6-week alignment check but was included in the data for the 2-week alignment.

Discussion

In 1995, Ward et al7 reported the successful use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery. Our study was performed in an attempt to discover a new and improved anesthetic technique that would build on the concepts of previous work.1, 2, 3, 4, 5, 6, 7, 8 Our method is based on the binary synergism between propofol and midazolam for hypnosis. It has been demonstrated that the hypnotic potency of propofol could be

References (8)

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  • Sedated suture adjustment in children undergoing adjustable suture strabismus surgery

    2017, Journal of AAPOS
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    In addition, it may decrease patient satisfaction and increase the use of surgical resources.11,13 Cogen and colleagues reported nausea occurring in 12% of their patients who were given propofol and midazolam for postoperative suture adjustment in the operating room immediately on completion of strabismus surgery.14 Nausea or vomiting were reported in only 9 patients (3%) in our study, none of whom required suture adjustment.

  • Effect of Slow-Releasing All-Trans-Retinoic Acid in Bioabsorbable Polymer on Delayed Adjustable Strabismus Surgery in a Rabbit Model

    2009, American Journal of Ophthalmology
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    The best timing for adjustment after strabismus surgery is a controversial issue. Some surgeons preferred immediate or early adjustment considering rapid recovery, and others have suggested that delayed adjustment may be desirable.25–28 However, postoperative drift largely affects final ocular alignment, and the greatest amount of drift occurred in the first 6 weeks.29

  • Adjustable suture strabismus surgery in infants and children

    2008, Journal of AAPOS
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    They used a limbal conjunctival approach, however, which in our experience is associated with more postoperative discomfort than the cul-de-sac approach. Surgeons used adjustment in the immediate postoperative period have tended to recommend either using sub-Tenon's ropivacaine to minimize the postoperative pain10 or conscious sedation or anesthesia using midazolam or propofol.11,12 Another way to minimize maneuvers is to use one of several optionally adjustable techniques.

  • Authors' reply

    2006, Journal of AAPOS
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*

Supported by an unrestricted grant from Research to Prevent Blindness, Inc, New York, New York, and the Alabama Eye Institute.

☆☆

Reprint requests: Martin S. Cogen, MD, Suite 601, 700 18th St S, Birmingham, AL 35233.

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