The use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery

J. B. Ward, A. S. Niffenegger, C. W. Lavin, M. A. Acquadro, D. K. Ahern, P. V. Smith, Craig McKeown

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Purpose: Adjustable Suture techniques have become increasingly popular over the last decade and may reduce the re-operation rate after strabismus surgery. The adjustment usually is made in the hospital or office 5 to 24 hours after surgery, when the patient has fully recovered from general anesthesia. The ability to perform suture adjustment in the operating room, immediately after completion of surgery, would be an attractive alternative with respect to patient monitoring, sterility, comfort, and timing. The purpose of this study is to compare the alignment of patients in the operating room adjusted immediately after surgery with their alignment the morning after surgery. Methods: Patients with strabismus who have good vision in each eye and who were judged to be appropriate candidates for adjustable sutures were invited to enroll in a study using propofol and mivacurium total intravenous anesthetic technique. Patients underwent strabismus surgery in which one or more muscles were placed on adjustable sutures. Immediately after extubation, these patients were awakened in the operating room, assisted in sitting upright, and asked to fixate on a 20/400 Snellen E target on the operating room wall. Sutures were adjusted, when necessary, to obtain the desired postoperative alignment. Prism and alternate cover measurements, taken after the sutures were permanently tied, were compared with measurements taken the morning after surgery. Results: Twenty-nine patients qualified for inclusion. Measurements of horizontal and vertical alignment in the operating room were all within 12 prism diopters (PD) of the measurements taken 18 to 24 hours after surgery (mean variation, 4 PD horizontally and 2 PD diopters vertically). The measured deviation changed less than or equal to 6 PD horizontally in 78% of patients and less than or equal to 3 PD vertically in 70% of patients. Conclusion: For some adult patients with strabismus, a total intravenous general anesthesia technique using an infusion of propofol and mivacurium may provide the opportunity for accurate suture adjustment in the operating room, immediately after completion of surgery.

Original languageEnglish
Pages (from-to)122-128
Number of pages7
JournalOphthalmology
Volume102
Issue number1
StatePublished - Jan 1 1995
Externally publishedYes

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Social Adjustment
Strabismus
Propofol
Sutures
Anesthetics
Operating Rooms
General Anesthesia
Intravenous Anesthetics
mivacurium
Suture Techniques
Intravenous Anesthesia
Aptitude
Physiologic Monitoring
Infertility
Muscles

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Ward, J. B., Niffenegger, A. S., Lavin, C. W., Acquadro, M. A., Ahern, D. K., Smith, P. V., & McKeown, C. (1995). The use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery. Ophthalmology, 102(1), 122-128.

The use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery. / Ward, J. B.; Niffenegger, A. S.; Lavin, C. W.; Acquadro, M. A.; Ahern, D. K.; Smith, P. V.; McKeown, Craig.

In: Ophthalmology, Vol. 102, No. 1, 01.01.1995, p. 122-128.

Research output: Contribution to journalArticle

Ward, JB, Niffenegger, AS, Lavin, CW, Acquadro, MA, Ahern, DK, Smith, PV & McKeown, C 1995, 'The use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery', Ophthalmology, vol. 102, no. 1, pp. 122-128.
Ward JB, Niffenegger AS, Lavin CW, Acquadro MA, Ahern DK, Smith PV et al. The use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery. Ophthalmology. 1995 Jan 1;102(1):122-128.
Ward, J. B. ; Niffenegger, A. S. ; Lavin, C. W. ; Acquadro, M. A. ; Ahern, D. K. ; Smith, P. V. ; McKeown, Craig. / The use of propofol and mivacurium anesthetic technique for the immediate postoperative adjustment of sutures in strabismus surgery. In: Ophthalmology. 1995 ; Vol. 102, No. 1. pp. 122-128.
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abstract = "Purpose: Adjustable Suture techniques have become increasingly popular over the last decade and may reduce the re-operation rate after strabismus surgery. The adjustment usually is made in the hospital or office 5 to 24 hours after surgery, when the patient has fully recovered from general anesthesia. The ability to perform suture adjustment in the operating room, immediately after completion of surgery, would be an attractive alternative with respect to patient monitoring, sterility, comfort, and timing. The purpose of this study is to compare the alignment of patients in the operating room adjusted immediately after surgery with their alignment the morning after surgery. Methods: Patients with strabismus who have good vision in each eye and who were judged to be appropriate candidates for adjustable sutures were invited to enroll in a study using propofol and mivacurium total intravenous anesthetic technique. Patients underwent strabismus surgery in which one or more muscles were placed on adjustable sutures. Immediately after extubation, these patients were awakened in the operating room, assisted in sitting upright, and asked to fixate on a 20/400 Snellen E target on the operating room wall. Sutures were adjusted, when necessary, to obtain the desired postoperative alignment. Prism and alternate cover measurements, taken after the sutures were permanently tied, were compared with measurements taken the morning after surgery. Results: Twenty-nine patients qualified for inclusion. Measurements of horizontal and vertical alignment in the operating room were all within 12 prism diopters (PD) of the measurements taken 18 to 24 hours after surgery (mean variation, 4 PD horizontally and 2 PD diopters vertically). The measured deviation changed less than or equal to 6 PD horizontally in 78{\%} of patients and less than or equal to 3 PD vertically in 70{\%} of patients. Conclusion: For some adult patients with strabismus, a total intravenous general anesthesia technique using an infusion of propofol and mivacurium may provide the opportunity for accurate suture adjustment in the operating room, immediately after completion of surgery.",
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