Combined propofol sedation with sub-Tenon's lidocaine/mercaine infusion for strabismus surgery in adults

Abstract

Aims To evaluate the safety and efficacy of propofol sedation combined with sub-Tenon's anaesthesia for strabismus surgery in adults. Methods Thirty-two consecutive patients aged 31-85 years underwent strabismus surgery under general (n ¼ 16) or local (n ¼ 16) anaesthesia. In the local anaesthesia (study) group, sedation was induced with a loading dose of midazolam, fentanyl, and propofol, followed by continuous infusion of propofol, 3-6 mg/k/h to deep sedation. A nasal tube was inserted to prevent airway obstruction. SubTenon's anaesthesia included infusion of a 3-4 ml mixture (50 : 50) of lidocaine 2%/mercaine 0.5%. General anaesthesia consisted of premedication with midazolam, followed by fentanyl, esmeron-bromate, propofol, and tracheal intubation. Duration of surgery and anaesthesia, intraoperative oculocardiac reflex and arrhythmias, time to discharge, postoperative pain, nausea and vomiting, and patient and surgeon satisfaction were evaluated. Results The local anaesthesia group had a significantly shorter operative and anaesthesia time, fewer episodes of oculocardiac reflex or arrythmia/bradycardia requiring treatment, fewer early or late episodes of nausea and vomiting, and less pain. The patients and surgeon in this group reported higher satisfaction. Conclusion Propofol sedation with local subTenon's injection of lidocaine/mercaine is recommended for the induction and maintenance of anaesthesia during unilateral or bilateral strabismus surgery in adults. The method is quick and effective, without systemic or ocular side effects.

Adjustable suture strabismus surgery

“…25 This method of administration also reduces the likelihood of anesthetic-induced strabismus that can occur when the muscle is inadvertently injected with local anesthetic agents using the retrobulbar or peribulbar approach. 26 Bupivacaine (Marcaine) and other long-acting local anesthetics are not recommended for strabismus surgery if same-day suture adjustment is desired.…”