Korean J Ophthalmol.  2008 Dec;22(4):246-250. 10.3341/kjo.2008.22.4.246.

Effect of Muscle Relaxants on Short-term Results of Exotropia Surgery: A Focus on Resection Procedures

• Chang YS
• Baek SH
• Park JM
• Kwon HU
• Kim YR

• KMID: 1084212
• DOI: http://doi.org/10.3341/kjo.2008.22.4.246

Abstract

PURPOSE: We investigated the effect of muscle relaxants (atracurium) on the outcomes of intermittent exotropia surgery under general anesthesia, with a focus on resection procedures. METHODS: Thirty four patients who underwent recession and resection (R&R) were divided into two groups: atracurium usage (group A, n=18) and no atracurium usage (group B, n=16). Patients were divided into two subgroups according to the amount of resection of the medial rectus (MR): less than 5 mm (group 1, n=13) or 5 mm and greater (group 2, n=21). Deviation angles were compared between groups and subgroups. Surgical outcome was defined as successful if distant deviation angles were equal to or less than 10 prism diopters. RESULTS: The overall postoperative deviation angles did not show statistically significant differences between groups A and B. However, in patients with larger MR resections (> or = 5 mm), the 1 week postoperative distant deviation was significantly larger in group A (1.8+/-2.6 PD) than in group B (-1.6+/-4.6 PD, p=0.048 by t-test). The overall undercorrection rate at 3 months postoperatively for group A was 16.7%, which was higher than that of group B (6.3%), and the difference was even larger in subgroups with larger MR resections (> or =5 mm): 18.2% in group A and 0% in group B. CONCLUSIONS: Patients who underwent R&R procedures under general anesthesia with a muscle relaxant tended to be less corrected than those without muscle relaxant, especially in the early postoperative period and with a larger MR resection equal to or greater than 5 mm. However, there was no significant difference in the later postoperative period.

Keyword

Atracurium; Extraocular muscles; General anesthesia; Intermittent exotropia; Muscle relaxant

MeSH Terms

Anesthesia, Inhalation
Atracurium/*administration & dosage
Child
Child, Preschool
Exotropia/*physiopathology/*surgery
Female
Humans
Injections, Intravenous
Male
Muscle Relaxation
Neuromuscular Nondepolarizing Agents/*administration & dosage
Oculomotor Muscles/*physiopathology
Ophthalmologic Surgical Procedures
Treatment Outcome

Reference

1. Meakin GH. Role of muscle relaxants in pediatric anesthesia. Curr Opin Anaesthesiol. 2007. 20:227–231.

2. Donati F, Meistelman C, Plaud B. Vecuronium neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis. Anesthesiology. 1991. 74:833–837.

3. Meistelman C, Plaud B, Donati F. Rocuronium (Org 9426) neuromuscular blockade at the adductor muscles of the larynx and adductor pollicis in humans. Can J Anaesth. 1992. 39:665–669.

4. Bencini A, Newton DE. Rate of onset of good intubating conditions, respiratory depression and hand muscle paralysis after vecuronium. Br J Anaesth. 1984. 56:959–965.

5. Pansard JL, Chauvin M, Lebreault C, et al. Effects of an intubating dose of succinylcholine and atracurium on the diaphragm and the adductor pollicis in humans. Anesthesiology. 1987. 67:326–330.

6. Donati F, Antzaka C, Bevan DR. Potency of pancuronium at the diaphragm and the adductor pollicis muscle in humans. Anesthesiology. 1986. 65:1–5.

7. Ungureanu D, Meistelman C, Frossard J, Donati F. The orbicularis oculi and the adductor pollicis muscles as monitors of atracurium block of laryngeal muscles. Anesth Analg. 1993. 77:775–779.

8. Ruff RL. More than meets the eye: Extraocular muscle is very distinct from extremity skeletal muscle. Muscle Nerve. 2002. 25:311–313.

9. Kaminski HJ, Al-Hakim M, Leigh RJ, et al. Extraocular muscles are spared in advanced Duchenne dystrophy. Ann Neurol. 1992. 32:586–588.

10. Porter JD, Baker RS. Muscles of a different "color": the unusual properties of the extraocular muscles may predispose or protect them in neurogenic and myogenic disease. Neurology. 1996. 46:30–37.

11. Porter JD, Baker RS, Ragusa RJ, Brueckner JK. Extraocular muscles: basic and clinical aspects of structure and function. Surv Ophthalmol. 1995. 39:451–484.

12. Ohtsuki H, Hasebe S, Kono R, et al. Prism adaptation response is useful for predicting surgical outcome in selected types of intermittent exotropia. Am J Ophthalmol. 2001. 131:117–122.

13. Lim ST, Kim SJ, Park YG. A clinical study : Change of the eye position under general anesthesia. J Korean Ophthalmol Soc. 1995. 36:2243–2251.

14. Scott WE, Keech R, Mash AJ. The postoperative results and stability of exodeviations. Arch Ophthalmol. 1981. 99:1814–1818.

15. Stoller SH, Simon JW, Lininger LL. Bilateral lateral rectus recession for exotropia: a survival analysis. J Pediatr Ophthalmol Strabisms. 1994. 31:89–92.