THE USE OF PROPOFOL AND MIVACURIUM ANESTHETIC TECHNIQUE FOR THE IMMEDIATE POSTOPERATIVE ADJUSTMENT OF SUTURES IN STRABISMUS SURGERY

Purpose: Adjustable suture techniques have become increasingly popular over the last decade and may reduce the re-operation rate after strab ismus surgery. The adjustment usually is made in the hospital or offic e 5 to 24 hours after surgery, when the patient has fully recovered fr om 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 align ment of patients in the operating room adjusted immediately after surg ery with their alignment the morning after surgery. Methods: Patients with strabismus who have good vision in each eye and who were judged t o be appropriate candidates for adjustable sutures were invited to enr oll in a study using propofol and mivacurium total intravenous anesthe tic technique. Patients underwent strabismus surgery in which one or m ore muscles were placed on adjustable sutures. Immediately after extub ation, 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 walt. Sutures were adjusted, when necessary, to obt ain the desired postoperative alignment. Prism and alternate cover mea surements, taken after the sutures were permanently tied, were compare d with measurements taken the morning after surgery. Results: Twenty-n ine patients qualified for inclusion. Measurements of horizontal and v ertical alignment in the operating room were all within 12 prism diopt ers (PD) of the measurements taken 18 to 24 hours after surgery (mean variation, 4 PD horizontally and 2 PD diopters vertically). The measur ed 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 intrave nous general anesthesia technique using an infusion of propofol and mi vacurium may provide the opportunity for accurate suture adjustment in the operating room, immediately after completion of surgery.