Anesthetic support for laser vision correction in children

Abstract

BACKGROUND: Currently, more and more laser surgeries are performed in pediatric ophthalmology. Expansion of indications for laser vision correction in children entails the increase in the number of patients and poses new specific tasks for pediatric anesthesiology. Solution of these problems is currently at the stage of active clinical search. AIM: To propose a safe, reproducible and controllable method of anesthesiological support at pediatric ophthalmic surgeries which would ensure complete immobility of the eyeball during the intervention and patient’s rapid awakening after the surgery. METHODS: A retrospective trial has been conducted. From October 2016 to May 2022, in the hospital of Joint Stock Company "Medicine" (clinic of Academician Roitberg) specialists from Yasny Vzor Children's Eye Clinics of Professor Igor Aznauryan operated on 429 children with ophthalmosurgical pathology. Laser vision correction was performed in children with refractive errors (astigmatism, hyperopia, congenital stable high myopia) complicated by anisometropia and/or amblyopia. The composite endpoint was surgeon's satisfaction with eye position during the main intervention and at the time of patient's awakening at the end of surgical stage. The surgeon's satisfaction was assessed with a 10-point scale, where 1 means no centration achieved and 10 means complete immobility during the correction. Awakening was the time from the end of surgical procedure until the removal of laryngeal mask after restoration of spontaneous breathing and signs of consciousness. RESULTS: All 429 patients included in the trial completed it. Awakening came quickly and lasted, on average, 13.3 min (95% confidence interval, 12.1–14.6 min). At the early postoperative period, pain syndrome was in significant and amounted to 1–3 points by the Face, Legs, Activity, Cry, Consolability Scale and to 1–2 points by the Visual Analogue Scale. Additional anesthesia (Ibuprofen) was required in less than 10% of patients. Nausea, vomiting, and muscle pain were not observed in the postoperative period. CONCLUSION: The proposed technique is adequate for ensuring the eyeball immobility and for acceptable wake-up time up to 9–10 points by the Aldreth scale.