不同时间给予昂丹司琼预防小儿斜视术后恶心呕吐的临床观察

目的：不同时间静脉注射昂丹司琼在小儿斜视术后恶心呕吐（postoperative nausea and vomiting,PONV）中的效果观察。方法：随机选择2013-06/08在我院拟行斜视手术的患儿90例,ASAⅠ～Ⅱ级,年龄3～11岁。随机分为3组,每组30例。A组在手术开始前静脉注射昂丹司琼0.1mg/kg; B组在手术结束后静脉注射昂丹司琼0.1mg/kg; C组为对照组,不用昂丹司琼。在术后24h内观察患者恶心、呕吐的发生例数及严重程度。结果：三组患者的性别、体重、年龄、麻醉时间、氯胺酮用量各组间比较无统计学意义（P〉0.05）。A,B组的PONV发生率明显低于C组（P〈0.05）,A组和B组的PONV发生率比较无统计学意义（P〉0.05）。结论：在手术前或手术结束时应用昂丹司琼可有效、安全地预防小儿斜视手术后的PONV,提高眼科手术安全性,且费用低,是一种值得推广应用的止吐方法。     

术前应用氟比洛芬酯与阿扎司琼对小儿斜视矫正术术后疼痛及呕吐的影响

目的 观察术前联合应用氟比洛芬酯与阿扎司琼对小儿斜视矫正术术后疼痛及恶心呕吐的影响.方法 临床病例对照研究.选择中山大学中山眼科中心就诊的60例按美国麻醉医师协会(ASA)标准的Ⅰ～Ⅱ级、年龄8～14岁、择期行斜视矫正术的患儿,均采用异丙酚、芬太尼及阿曲库胺全凭静脉麻醉,根据诱导前辅助用药的不同随机分为3组(n=20):FA组静脉推注氟比洛芬酯1mg/kg+阿扎司琼0.2mg/kg;F组给予氟比洛芬酯1mg/kg+等量生理盐水;A组给予阿扎司琼0.2mg/kg+等量生理盐水,均在诱导前10min静脉注射.观察术前、术始、术毕、术后各时点的镇痛评分(VAS)及血糖变化,并观察各组苏醒期躁动、术后咽喉部疼痛及恶心、呕吐等不良反应发生情况.结果 FA组和F组术后V.AS评分显著低于A组(P<0.05),术后各时点A组血糖水平明显高于FA组和F组(P<0.05),FA组和A组术后恶心呕吐发生率明显低于F组(P<0.05).结论 术前氟比洛芬酯与阿扎司琼联合应用于小儿斜视矫正术既可明显改善术后疼痛又能减少恶心呕吐等不良反应.

Abstract：

Objective To study the effect of preoperative flurbiprofen axetil combined with azasetron on postoperative pain and nausea and vomiting in children undergoing strabismus surgery. Methods A total of 60 children, ASA Ⅰ -Ⅱ, aged 8-14, scheduled for strabismus surgery with total intravenous general anesthesia were randomly assigned to 3 groups(n=20). In group FA, flurbiprofen axetil(1mg/kg)combined with azasetron(0.2mg/kg)was intravenously injected; only flurbiprofen axetil(1mg/kg)was give in group F and only azasetron(0.2mg/kg)was injected in group A. The above drugs were all administered 10 min before the anesthetic induction. VAS scores and glucose at the end of surgery and after surgery were recorded individually.The incidence rate of restless, nausea and vomiting after surgery were recorded. Results The incidence rate of pain in group FA and group F were significantly lower than that in group A(P <0.05). The postoperative glucose in group A were significantly higher than that in group FA and group F(P <0.05). The incidence rate of nausea and vomiting in group FA and group A were significantly lower compared with group F(P <0.05).Conclusions Flurbiprofen axetil combined with Azasetron can reduce the adverse reactions, such as pain,nausea and vomiting in children undergoing strabismus surgery.     

Postoperative nausea and vomiting after Faden operation

· Objective: The purpose of this study was to evaluate the antiemetic effect of prophylactic dimenhydrinate application prior to Faden operation and to compare the incidence of PONV between bimedial Faden operation (BMF) and horizontal recess-resect procedure (R&R). · Methods: Ninety-nine children (4–10 years) scheduled for BMF were included in this prospective double-blind study. Midazolam (0.5 mg/kg body weight, BW) was administered orally for premedication 30 min before induction of anesthesia. Additionally, children weighing ≥23 kg received either dimenhydrinate suppositories or placebo. The placebo group was compared with 148 children who underwent R&R surgery without antiemetic prophylaxis during the same period. Anesthesia was induced with thiopentone (5–10 mg/kg BW) and vecuronium (0.1 mg/kg BW) bromide and maintained with halothane (1–2 vol%) in N₂O/O₂ (65/35 vol%). Age, height, weight, and incidence of oculocardiac reflex were documented. PONV was classified into ”no vomiting”, ”vomiting without therapy”, and ”vomiting requiring rescue medication”. In the latter case dimenhydrinate was given again. The chi-square test was used for statistical analysis.  · Results: Forty-eight patients received placebo, while 51 received dimenhydrinate. No differences between any groups were observed concerning age, height, weight, and incidence of oculocardiac reflex. Compared to R&R surgery, PONV requiring rescue medication occurred significantly more frequently after BMF (45% vs 23% after R&R). PONV after BMF was significantly less severe in the dimenhydrinate group than in the placebo group. The total incidence of PONV after BMF, however, was not significantly reduced. · Conclusion: The high incidence of PONV after BMF can be explained by the greater invasiveness of BMF than R&R surgery. PONV requiring antiemetic rescue medication can be reduced by preoperative administration of dimenhydrinate suppositories. Received: 3 November 1998 Revised version received: 5 February 1999 Accepted: 18 February 1999     

Droperidol and dolasetron alone or in combination for prevention of postoperative nausea and vomiting after vitrectomy

PURPOSE: Droperidol and the new serotonin-3 antagonists are effective drugs for the prophylaxis of postoperative nausea and vomiting (PONV). The aim of this trial was to evaluate whether dolasetron could be a substitute for droperidol, because the Food and Drug Administration has required a Black Box warning on the droperidol package insert. DESIGN: Randomized, placebo-controlled, double-blinded trial. PARTICIPANTS: Inpatients undergoing vitreoretinal surgery (standard 3-port pars plana vitrectomy for proliferative diabetic vitreoretinopathy, complicated retinal detachment, or macular disease, such as macular pucker, macular hole, or choroidal neovascularization). INTERVENTION: Two hundred forty patients (3x80) receiving droperidol (10 microg. kg(-1)), dolasetron (12.5 mg), or the combination of both drugs administered 5 to 10 minutes before the end of surgery. CONTROL: Eighty patients received saline placebos as controls. METHODS: Standardized general anesthesia was performed, including benzodiazepine premedication, propofol, atracurium or vecuronium, desflurane in N(2)O/O(2), and a continuous infusion of remifentanil. Postoperative analgesia and antiemetic rescue medication were standardized. Episodes of vomiting, retching, nausea, and the need for additional antiemetics were recorded for 24 hours. MAIN OUTCOME MEASURES: Severity of PONV (rated by a standardized scoring algorithm) was analyzed as the main end point of the study using the Kruskal-Wallis test. RESULTS: Data of 304 patients could be analyzed. Mean severity scores in the placebo, dolasetron, droperidol, and combination groups were 1.21, 0.76, 0.47, and 0.30. Incidences of PONV of any severity were 56%, 40%, 28%, and 18%, respectively. The reduction of the incidence of PONV and its severity was statistically significant in the droperidol group and in the combination group relative to the placebo. Dolasetron alone failed to reduce the incidence of PONV. The combination of dolasetron and droperidol showed an additive antiemetic efficacy. CONCLUSION: Low-dose droperidol (10 microg. kg(-1)) but not dolasetron (12.5 mg) reduced postoperative nausea and vomiting after vitreoretinal surgery. Dolasetron (12.5 mg) is not an equivalent substitute for droperidol.     

阿扎司琼预防眼外伤手术后恶心呕吐的观察

目的观察比较阿扎司琼(azasetron)预防眼外伤手术后恶心呕吐的效果。方法眼外伤手术75例,随机分为对照组(A组)、氟哌利多(droperidol)组(B组)和阿扎司琼组(C组),每组25例。在手术结束前,A、B、C组分别静脉注射生理盐水5mL、氟哌利多5mg或阿扎司琼10mg,观察每位患者用药后恶心呕吐发生情况。结果眼外伤手术后恶心呕吐的发生大多数在术后24h内,呕吐发生率,C组小于B组(P<0.05),B组小于A组(P<0.05)。结论本研究表明阿扎司琼是一种安全有效的预防眼外伤手术后恶心呕吐的药物。     

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

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=16) or local (n=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. Sub-Tenon'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 sub-Tenon'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.     

The Effect of Amblyopia Therapy on Ocular Alignment

PURPOSE: We sought to describe the change in ocular alignment at 2 years after treatment of amblyopia in children younger than 7 years of age at enrollment. METHODS: A randomized clinical trial of patching versus atropine for 6 months followed by standard clinical care for 18 months was conducted in 357 children with anisometropic, strabismic, or combined amblyopia (20/40-20/100) whose ages ranged from 3 to younger than 7 years at enrollment. Ocular alignment was evaluated at enrollment and after 2 years of follow-up. RESULTS: At enrollment when tested at distance fixation, 161 (45%) children were orthotropic, 91 (25%) had a microtropia (1-8 Delta), and 105 (29%) had a heterotropia >8 Delta. Of the 161 patients with no strabismus, similar proportions of patients initially assigned to the patching and atropine groups developed new strabismus by 2 years (18% vs. 16%, P = 0.84). Of these cases of new strabismus, only 2 patients in the patching group and 3 patients in the atropine group developed a deviation that was greater than 8 Delta. Microtropia at enrollment progressed to a deviation greater than 8 Delta with similar frequency in both treatment groups (13% vs. 15%, P = 1.00). Of the 105 patients with strabismus greater than 8 Delta at enrollment, 13% of those in the patching group and 16% of those in the atropine group improved to orthotropia without strabismus surgery. Strabismus surgery was performed in 32 patients during the 2-year study period. CONCLUSIONS: Patients who had amblyopia treatment with patching or atropine for 6 months followed by standard clinical care were found to have similar rates of deterioration and improvement of ocular alignment. When parents begin amblyopia treatment for children without strabismus, they should be warned of the possibility of development of strabismus, although it is most often a small angle deviation. Strabismus resolved after amblyopia therapy in some cases.     

球后麻醉及阿托品预处理对小儿斜视手术眼心反射的影响

目的:比较全身麻醉、全身麻醉联合球后麻醉或阿托品三种麻醉方法对小儿斜视手术眼心反射(oculocardiac reflex,OCR)发生率的影响.方法:将2015-03/2016-03在我院行斜视矫正手术并采用全身麻醉的5~13岁患者92例166眼纳入研究,随机分为全身麻醉组29例55眼、全身麻醉+球后麻醉组31例54眼、全身麻醉+阿托品组32例57眼;全身麻醉组采用静脉注射丙泊酚2 mg/kg、芬太尼1 mg/kg和阿曲库铵0.5 mg/kg.全身麻醉+球后麻醉组于全身麻醉基础上球后注射20 g/L利多卡因2 mL.全身麻醉+阿托品组于全身麻醉基础上于术前加用静脉注射阿托品0.15 mg/kg.手术期间牵拉眼外肌所造成的最低心率低于心率基线值的10%以上或出现心律失常即为OCR阳性.记录术前心率基线值,术中手术时间、麻醉时间及术中OCR发生的肌肉数,术后随访6 mo并记录眼球正位例数.结果:全身麻醉+球后麻醉组的OCR发生率最低(20%),其次为全身麻醉+阿托品组(22%),两种麻醉方法OCR发生率均低于全身麻醉组(58%).三种麻醉方法在麻醉时间、手术时间、心率基线值以及手术后眼位正位率方面无统计学差异(P>0.05).结论:小儿斜视全身麻醉手术联合球后麻醉或阿托品预处理,可有效地降低术中OCR的发生率,能够为斜视患儿提供更安全的手术保障.     

Ondansetron for the prevention and treatment of nausea and vomiting following pediatric strabismus surgery

BACKGROUND: Neither droperidol nor ondansetron has been proven completely effective, and there are conflicting data comparing the efficacy of the two agents. The purpose of this study was to compare the efficacy, safety and cost of a combination of ondansetron administered intravenously in the operating room followed by oral ondansetron treatment at home with the more commonly used treatment of intravenous droperidol therapy and oral dimenhydrinate therapy, for the prevention and treatment of postoperative nausea and vomiting in children undergoing strabismus surgery. METHODS: Double-blind randomized clinical trial with parallel comparison groups. All patients aged 6 months to 18 years who underwent strabismus surgery at a pediatric hospital in Montreal between Nov. 13, 2000, and June 12, 2001, were included. The exclusion criteria were nausea or vomiting, or use of antiemetics or narcotics in the 24 hours preceding surgery, and past history of hepatic, gastric or renal disease. The outcome measures were frequency of nausea and vomiting, severity of nausea and adverse effects in hospital, during transportation home and during the first 24 hours at home. Data were obtained through nursing notes and through a telephone interview conducted 24 to 48 hours after discharge. RESULTS: Of the 208 eligible patients, 172 were randomly assigned to the study groups (88 to the ondansetron group and 84 to the droperidol/dimenhydrinate group). We found no statistically significant difference in the incidence of nausea and vomiting in hospital or at home between the two groups (25.3% vs. 31.6%, p = 0.371). There was a significant difference between the two groups in the rate of vomiting during transportation home (3.6% vs. 12.6%, p = 0.044). The incidence of severe nausea was 14.4% with ondansetron and 15.4% with droperidol, a nonsignificant difference (p = 1.00). No significant difference was observed between the two groups in the incidence of any nausea (p = 0.434) or adverse effects (p = 0.220). We calculated that the combination of droperidol and dimenhydrinate was seven times less costly than the ondansetron regimen. INTERPRETATION: In this study, the efficacy and safety of intravenous administration of droperidol followed by oral use of dimenhydrinate did not differ from that of intravenous followed by oral use of ondansetron in children undergoing strabismus surgery. Since treatment with ondansetron is much more costly than the combination of droperidol and dimenhydrinate, at this time the use of ondansetron in the prevention and treatment of vomiting and nausea in this population may not be beneficial on a cost basis if all other variables are considered.     

Nausea and vomiting after phacoemulsification using topical or retrobulbar anesthesia

PURPOSE: To determine and compare the incidence of postoperative nausea and vomiting in patients having phacoemulsification under topical or retrobulbar anesthesia. SETTING: Department of Ophthalmology, United Christian Hospital, Hong Kong, China. METHODS: In this prospective randomized clinical trial, patients scheduled for routine phacoemulsification with posterior chamber intraocular lens implantation under local anesthesia without sedation were randomized to receive topical anesthesia or retrobulbar anesthesia. One hundred seven eyes of 107 Chinese patients were included. There were 49 patients and 58 patients of similar age and sex distribution in the retrobulbar group and topical group, respectively. Postoperative nausea and vomiting (PONV), the need for an antiemetic, and intraocular pressure (IOP) were recorded 1 day after surgery. Also recorded were the patient's preexisting risk factors for PONV (if any), fasting time, duration of surgery, and intraoperative complications or need for supplementary anesthesia or analgesia. RESULTS: The overall incidence of PONV in the entire study group was 3.7% (4 patients). No statistically significant differences in PONV were found between the 2 anesthesia techniques, although 6.1% (3 of 49) in the topical group had nausea compared with 1.7% (1 of 58) in the retrobulbar group. No significant differences were found in the fasting time, duration of surgery, or postoperative IOP between patients who had PONV and those who did not. CONCLUSIONS: Topical and retrobulbar anesthesia were associated with a low incidence of PONV in routine phacoemulsification. There were no statistically significant differences in PONV between the 2 anesthesia techniques. No significant correlation was found between the incidence of PONV and the duration of surgery, presence of complications, fasting time, postoperative IOP, or history of PONV or motion sickness.     

Preoperative oral granisetron for the prevention of vomiting after strabismus surgery in children.

OBJECTIVE: To evaluate the efficacy of oral granisetron for the prevention of postoperative vomiting in children undergoing strabismus surgery. DESIGN: Prospective, randomized, double-masked, placebo-controlled study. PARTICIPANTS: A total of 120 children, 4-10 years of age, scheduled for elective strabismus surgery. INTERVENTION: Patients received oral placebo or granisetron at three different doses (20 microg/kg, 40 microg/kg, 80 microg/kg) 1 hour before surgery. MAIN OUTCOME MEASURES: A complete response, defined as no vomiting, no retching, and no need for rescue antiemetic medication, during the first 24 hours after anesthesia was recorded. RESULTS: A complete response during 0-24 hours after anesthesia occurred in 33% of those who received placebo, 40% who received granisetron 20 microg/kg, 83% who received granisetron 40 microg/kg, and 87% who received granisetron 80 microg/kg (P < 0.05, overall Fisher's exact probability test). CONCLUSION: Preoperative oral granisetron, in doses more than 40 microg/kg, is effective for preventing vomiting after strabismus surgery in children.     

Treatment of vomiting after paediatric strabismus surgery with granisetron,droperidol, and metoclopramide

We have compared the efficacy and safety of granisetron, droperidol, and metoclopramide in the treatment of postoperative vomiting (POV) in children scheduled for strabismus surgery. After experiencing POV during the first 3 h after recovery from anaesthesia, 120 patients received intravenously, in a randomized, double-blind manner, granisetron 40 microg/kg, droperidol 50 microg/kg, or metoclopramide 0.25 mg/kg (n = 40 in each group). The patients were then observed for 24 h after administering the study drugs. Emesis-free episodes were more often observed in patients who had received granisetron (88%) than in those who had received droperidol (63%) or metoclopramide (58%; p < 0.05). No clinically serious adverse events were observed in any group. In conclusion, granisetron is more effective than droperidol or metoclopramide in the treatment of POV after paediatric strabismus surgery.     

枢丹防止儿童斜视矫正术后恶心呕吐的临床观察

目的 评价儿童斜视矫正手术中应用3型5-羟色胺受体拮抗剂—枢丹防止术后恶心呕吐的效果。方法将40例斜视矫正手术患儿随机分为两组,A组术中静滴枢丹2 mg。B组未用任何止吐药。两组患儿术中均为氯胺酮麻醉。记录用药前后平均动脉压(MAP)、心率(HR)、脉博血氧饱和度(SPO_2)的改变及术后24小时内恶心呕吐的发生率。结果 A组术后恶心呕吐的发生率明显低于B组(P<0.05),而用药前后患儿平均动脉压、心率及脉博血氧饱和度差异均无显著意义(P>0.05)。结论 枢丹能有效防止儿童斜视矫正术后的恶心呕吐,而且对患儿生命体征影响很小。     

Ramosetron compared with granisetron for the prevention of vomiting following strabismus surgery in children

BACKGROUND/AIMS: Postoperative vomiting occurs frequently after strabismus surgery in children. Granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting following paediatric strabismus surgery. Ramosetron, another new antagonist of 5-hydroxytryptamine type 3 receptor, has more potent and longer acting properties than granisetron against cisplatin induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting following strabismus surgery in children. METHODS: In a randomised, double blinded manner 80 children, aged 4-10 years, received intravenously granisetron 40 microg/kg or ramosetron 6 microg/kg (n=40 each) at the end of surgery. A standard general anaesthetic technique and postoperative analgesia were used. Emetic episodes and safety assessment were performed during the first 24 hours and the next 24 hours after anaesthesia. RESULTS: The percentage of patients who were emesis free during 0-24 hours after anaesthesia was 85% with granisetron and 90% with ramosetron, respectively (p = 0.369); the corresponding rate during 24-48 hours after anaesthesia was 70% and 95% (p = 0.003). No clinically serious adverse events caused by the study drug were observed in any of the groups. CONCLUSION: Prophylactic antiemetic therapy with ramosetron is comparable with granisetron for the prevention of vomiting during 0-24 hours after anaesthesia in children undergoing strabismus surgery. During 24-48 hours after anaesthesia, ramosetron is more effective than granisetron for prophylaxis against postoperative vomiting.     

Resurgence of combined intravenous Ketamine and regional anesthesia in pediatric ocular surgery in COVID-19 pandemic

Purpose:The current pandemic of COVID-19 has made airway procedures like intubation and extubation, potential sources of virus transmission among health care workers. The aim of this work was to study the safety profile of combined ketamine and regional anesthesia in pediatric ocular surgeries during the COVID-19 pandemic.Methods:This prospective study included pediatric patients undergoing ocular surgery under general anesthesia from April to October 2020. Children were premedicated with oral midazolam (0.25–0.50 mg/kg) or intramuscular ketamine (7-10 mg/kg), ondensetron (0.1 mg/kg) and atropine (0.02 mg/kg). Anesthesia was achieved with intravenous ketamine (4–5 mg/kg) and local anesthesia (peribulbar block or local infiltration). The patient''s vital signs were monitored. Serious complications and postoperative adverse reactions related to anesthesia were documented.Results:A total of 55 children (62 eyes) were operated. Lid tear was the most common surgical procedure performed [n = 18 (32.7%)]. Dose of ketamine needed ranged from 30 to 120 mg (66.67 ± 30.45). No intubation or resuscitation was needed. Four children complained of nausea and two needed an additional dose of intravenous ondansetron due to vomiting in the post-operative period. Incidence of postoperative nausea and vomiting was not affected by age, duration of surgery or dose of ketamine used (P > 0.05). There was no correlation between increase in pulse and dose of ketamine.Conclusion:Combined ketamine and regional anesthesia is a safe and effective alternative to administer anesthesia in a child during ocular surgeries.     

The effect of topical tetracaine eye drops on emergence behavior and pain relief after strabismus surgery.

INTRODUCTION: Pediatric strabismus surgery may be associated with postoperative nausea, vomiting, and emergence agitation (restlessness, thrashing, crying, moaning, disorientation). We hypothesize that emergence agitation after strabismus surgery is in part related to pain and that topical tetracaine ophthalmic drops can decrease the intensity and incidence of postoperative pain and emergence agitation. METHODS: Eighty-eight subjects aged 1 to 12 years scheduled for strabismus surgery were enrolled in a double-masked randomized control trial. The patients were randomized to one of three groups: Group A received normal saline drops before and after surgery; Group B received normal saline drops before and tetracaine 1% drops after surgery; Group C received tetracaine 1% drops before and after surgery. An observer masked to group assignment assessed each patient in the postanesthesia care unit (PACU) using both a behavior scale and a modified behavioral pain scale. RESULTS: Patients in Group A were found to be in significantly more pain than Groups B or C at 5 minutes after arrival to the PACU (p < 0.013). Using the behavior scale, a significantly greater proportion of patients in Group A were crying or crying and thrashing at 5, 15, and 30 minutes after arrival to the PACU (5 minutes, p < 0.019; 15 minutes, p < 0.041; 30 minutes, p < 0.021). There was no significant difference between groups in total PACU time, PACU vomiting, PACU morphine use, or pain at home. CONCLUSIONS: Postoperative strabismus surgery pain was improved by the use of preoperative, and pre- and postoperative, tetracaine drops. Emergence agitation was not fully evaluated by the behavioral scale, and therefore, the effect of tetracaine drops on emergence agitation was not clarified. This study suggests that tetracaine drops can lead to a less stressful early postoperative experience for the patient.     

局部麻醉或辅助地西泮在斜视矫正术中的作用

目的　应用面部表情分级评分（ｆａｃｅｒａｔｉｎｇｓｃａｌｅ,ＦＲＳ）、焦虑评分（ｓｅｌｆ-ｒａｔｉｎｇａｎｘｉ-ｅｔｙｓｃａｌｅ,ＳＡＳ）,观察共同性斜视矫正术患者应用局部麻醉及麻醉前应用地西泮注射液的效果,比较手术前、后的疼痛情况、焦虑、术中牵拉不适及术后随访情况。方法　对２０１２年８月至２０１４年８月在我院住院的眼科共同性斜视患者８８例（１０８眼）,年龄１１～４０岁,进行显微镜下斜视矫正术,采用随机、对照、双盲的研究方法,随机分为两组:对照组４４例５４眼（局部注射盐酸罗哌卡因注射液）,用药组４４例５４眼术前辅助肌肉注射地西泮注射液０．２ｍＬ·ｍｇ－１。记录术中、术后１ｈ的ＦＲＳ、ＳＡＳ,同时记录术中患者手术时间、牵拉反射及随访情况。结果　用药组与对照组患者术中、术后ＦＲＳ差异均有统计学意义（均为Ｐ＜０．０５）。用药组与对照组患者ＳＡＳ评分术中、术后差异均有统计学意义（均为Ｐ＜０．０５）。用药组手术时间较对照组缩短（均为Ｐ＜０．０５）;用药组患者牵拉反射不适减轻,与对照组差异有统计学意义（Ｐ＜０．０５）,同时用药组患者手术中生命体征平稳,更好配合医师手术。结论　局部麻醉手术辅助术前应用抗焦虑、镇静药物行斜视矫正术具有较好的镇痛效果;明显缓解因术中精神紧张、疼痛及恶心等所致眼位异常,提高手术舒适度、减轻术后不适感,术中医师操作顺利、术后眼位复位较好。     

Timing of postoperative adjustment in adjustable suture strabismus surgery.

PURPOSE: The use of adjustable sutures in strabismus surgery has increased the rate of surgical success. Little data are available on the optimum timing for postoperative adjustment after strabismus surgery. We wanted to compare 2 common practices of adjustable suture technique after strabismus surgery. METHODS: Two comparable groups of 40 patients each, who had strabismus surgery with adjustable suture technique, were prospectively studied. Group A had early adjustment the same day of the surgery about 6 hours after the operation, and group B had late adjustment the next day about 24 hours after the operation. Subjective scoring tables were used to evaluate the pain felt by the patient before, during, and after the adjustment and any difficulties of the adjustment process. Requirements of postoperative pain medications and final alignment 6 weeks after surgery were also compared. RESULTS: Despite adequate statistical power, no significant differences were found between the groups regarding pain before, during, and after adjustment, difficulties performing the adjustment, and final alignment after 6 weeks (P > .05). Both adjustment schedules were equally associated with mild to moderate pain before, during, and after the adjustment. In the first 24 hours after surgery, no overall difference in the use of pain medications was found. Nausea and vomiting in the first 24 postoperative hours were more common in the early adjustment group (P = .02). CONCLUSION: The surgeon can feel free to choose the timing for postoperative adjustment. However, when performing an early adjustment, the surgeon should be especially prepared to control nausea and vomiting.     

Comparison of halothane/thiopental and propofol anesthesia for strabismus surgery.

Day case surgery has become a widely accepted practice for many ophthalmological procedures including strabismus surgery. Prompt recovery from anesthesia and minimal postoperative morbidity are especially requested to the anesthesiologists to deal with the high day case surgery burden. The purpose of this study was to compare two anesthesia techniques, halothane/thiopental anesthesia and propofol anesthesia, for patients undergoing monocular strabismus surgery. We studied the level of postoperative consciousness, nausea and vomiting, ocular pain, starting oral intake and activity in 43 patients, ranging from 7 to 41 years of age. A scoring system was used to assess these parameters in the first postoperative 48 h. Although there was not a significant difference in the level of ocular pain, the propofol group had less morbidity in terms of having a better level of consciousness and appetite, less nausea and vomiting and enhanced activity than the halothane/thiopental group. We conclude that propofol anesthesia has significant advantages over halothane/thiopental anesthesia on an outpatient basis for strabismus surgery.     

Strabismus surgery using the intraoperative adjustable suture method under anesthesia with propofol

PURPOSE: To evaluate the feasibility and efficacy of using the intraoperative adjustable suture method with anesthesia induced by intravenously administered propofol for strabismus surgery. METHODS: Seven adult patients (mean age, 29.7 +/- 18.5 years) with different types of strabismus were enrolled in this study. All patients underwent full ophthalmological and general medical examinations before surgery. Surgery was performed after induction of anesthesia using intravenously administered propofol that was titrated to control consciousness. RESULTS: Arousal of consciousness was observed at approximately 2 minutes after discontinuation of the propofol infusion in each case, and the consciousness level was sufficient to allow accurate cover-uncover testing and intraoperative adjustment of sutures. Minor complications of nausea in three patients and vomiting in one patient were noted after surgery. CONCLUSIONS: Strabismus surgery using the adjustable suture method with propofol intravenous anesthesia appears to be safe and useful for the treatment of adult strabismus.