J Korean Ophthalmol Soc.  2016 Apr;57(4):540-545. 10.3341/jkos.2016.57.4.540.

The Change of Severity of Epiblepharon after Induction of Total Intravenous Anesthesia without Muscle Relaxant

• Kim YJ
• Kim DG
• Lee GM
• Lim SH
• Yang JW

• KMID: 2212785
• DOI: http://doi.org/10.3341/jkos.2016.57.4.540

Abstract

PURPOSE
To investigate the changes of epiblepharon by evaluating the severity of epiblepharon before and after induction of general anesthesia (GA) with a muscle relaxant and total intravenous anesthesia (TIVA) without a muscle relaxant.
METHODS
Thirteen pediatric patients (26 eyes) underwent surgery for epiblepharon under GA using a muscle relaxant and 19 pediatric patients (38 eyes) underwent surgery for epiblepharon under TIVA without a muscle relaxant. The severity of epiblepharon in each eye was scored according to skin-fold height (scored 1-4) and area of ciliocorneal touch (scored 1-3) while the patient was in the supine position before induction and after induction of GA.
RESULTS
Skin-fold height scores and ciliocorneal touch area scores decreased after induction of GA with a muscle relaxant (skin-fold height score before GA: 2.42 ± 0.86, after GA: 1.87 ± 0.88 p-value < 0.001; ciliocorneal touch area score before GA: 2.05 ± 0.70, after GA: 1.61 ± 0.68, p-value < 0.001). In the TIVA group, skin-fold height scores and ciliocorenal touch area scores were not statistically different before and after GA (skin-fold height score before GA: 2.23 ± 1.18, after GA: 2.38 ± 1.10, p-value = 0.212; ciliocorneal touch area score before GA: 2.06 ± 0.74, after GA: 1.94 ± 0.80, p-value = 0.161).
CONCLUSIONS
The change of epiblepharon severity was significantly reduced by induction of TIVA without a muscle relaxant and there was no recurrence of epiblepharon 3 months after surgery. When using TIVA without a muscle relaxant, the change of epiblepharon severity was reduced and thus, this method can help prevent its undercorrection.

Keyword

Epiblepharon; Muscle relaxant; Total intravenous anesthesia

MeSH Terms

Anesthesia, General
Anesthesia, Intravenous*
Humans
Recurrence
Supine Position

Figure

• 

  Figure 1. Classification of skin-fold height. According to the highest line of the skin fold located in the primary eye position opened as widely as possible. (A) Below the lower lid margin. (B) Just below or on the lower lid margin, without concealing the lid margin. (C) Above the lower lid margin with concealment of less than the medial one third of the lid margin. (D) Above the lower lid margin with concealment of more than the medial one third of the eyelid margin.

• 

  Figure 2. Classification of ciliocorneal touch. According to when the cilia touched the cornea. (A) Only in downgaze and not in primary gaze. (B) Less than the medial one half of the cornea. (C) More than one half of the cornea.

• 

  Figure 3. Comparison of degree of epiblepharon between the induction of GA in the muscle relaxant group. Before the induction of GA, the average value of the skin-fold height score was 2.42. After induction of GA, the average value of the skin-fold height score was 1.87. Before induction of GA, the average ciliocorneal touch score was 2.05. After induction of GA, the average ciliocorneal touch score was 1.61. Skin-fold height score and ciliocorneal touch score were significantly different before and after the induction of GA with muscle relaxant. GA = general anesthesia. *p<0.001.

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  Figure 4. Class proportion of skin-fold height score and ciliocorneal touch score between before and after the induction of GA with muscle relaxant. N = number of eyes; GA = general anesthesia.

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  Figure 5. Comparison of degree of epiblepharon between induction of GA without muscle relaxant in the TIVA group. Before the induction of GA, the average skin-fold height score was 2.23. After the induction of GA, the average skin-fold height score was 2.38. Before the induction of GA, the average ciliocorneal touch score was 2.08. After the induction of GA, the average ciliocorneal touch score was 1.94. Skin-fold height score and ciliocorneal touch score were not significantly different before and after the induction of GA . TIVA = total intravenous anesthesia; GA = general anesthesia.

Reference

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