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Warachaya Phanphruk, Maan Alkharashi, Aykut Bilge, David G Hunter; Sedated suture adjustment in children undergoing adjustable-suture strabismus surgery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2437.
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While access to post-operative sedation makes adjustable sutures an option for patients of any age, there are no published studies of the methods and potential complications of sedated adjustment in the post-anesthesia care unit (PACU.)
We reviewed the post-operative experience of children ≤ 18 years undergoing adjustable suture strabismus surgery performed by Boston Children’s Hospital surgeons over a 2-year period. Time in the hospital, anesthesia-related complications, and surgical outcomes were reviewed to evaluate safety and health care resource utilization.
Of the 356 patients meeting inclusion criteria, 113 (31.7%) required suture adjustment in the PACU, including 24 (ages 12 - 18 yr) adjusted while awake and 89 (ages 1-18 yr) adjusted under sedation. For sedation, sequential boluses of propofol were administered until adjustment was complete. Complete data from the sedated adjustment was available in 76 patients. Median initial bolus was 20.0 mg [range, 10 - 100 mg]; median total propofol dose was 270.6 mg [range 62.0 - 668.3 mg]. Twelve patients (15.8%) required only a single bolus of propofol (median dose 30 mg; range 20 - 100 mg). Of the remaining 64 patients, median time from initial to final propofol dose was 7.0 min [range, 1 - 27 min]. Median anesthesiologist time at bedside in the PACU was 13.0 min [range, 5 - 34 min]. In the sedated adjustment group, there was no clinically significant bradycardia, oxygen desaturation, or post-operative nausea/vomiting, with a moderate pain score (4-7) recorded in 1 patient (1.3%). Median PACU stay in the three groups was 132 minutes (non-adjusted), 154 min (adjusted awake), and 205 min (adjusted with sedation). The 2-month surgical success rate for the entire group was 71.8 % for horizontal strabismus and 82.0 % for vertical strabismus.
Sedated suture adjustment allows for fine-tuning of post-operative binocular alignment in the PACU. No severe complications were observed in our study group. This work will inform disclosure of risks and benefits of sedated adjustment while allowing for more accurate assessment of the cost and quality of adjustable sutures in children.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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