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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 Oct 12

DOI: 10.23736/S0375-9393.17.12282-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Immobilisation during anaesthesia for vitrectomy using a laryngeal mask without neuromuscular blockade versus endotracheal intubation and neuromuscular blockade

Axel FUDICKAR 1 , Matthias GRUENEWALD 1, Beate FUDICKAR 1, Moritz HILL 1, Martin WALLENFANG 1, Julia HÜLLEMANN 1, Dana VOSS 1, Amke CALIEBE 2, Johann B. ROIDER 3, Markus STEINFATH 1, Felix TREUMER 3

1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; 2 Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany; 3 Department of Ophthalmology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany


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BACKGROUND: For intraocular surgery, most authors recommend general anaesthesia including intubation and neuromuscular blockade to avoid complications by patient movements. However, anaesthesia using a laryngeal mask and avoidance of muscle relaxants is common clinical practice. Purpose of this prospective observational study was to compare the incidence of eye movement and deviation of the eye axis during general anaesthesia adjusted to minimal alveolar concentration (MAC) for pars plana-vitrectomy (PPV) using a laryngeal mask without neuromuscular blockade (LM) versus endotracheal intubation and neuromuscular blockade (INT).
METHODS: 148 patients that underwent PPV for vitreoretinal disorders received MAC adjusted general anaesthesia by volatile anaesthetics. 74 patients were subjected to LM and 74 patients to INT. In both groups the patient ́s lungs were mechanically ventilated without allowing spontaneous ventilation. Eye movements and upward deviations were judged and documented during surgery. Postoperatively quality of immobilisation was assessed by a standardised questionnaire.
RESULTS: Intraoperative movements were not observed in either group. Upward eye deviation was observed in 9 (12%) of patients in the LM group, but not in patients in the INT group (0%; p=0.003). The standardised questionnaire revealed no clinically relevant difference in quality of immobilisation between groups, especially eye deviations did not lead to any relevant surgical complications or difficulties.
CONCLUSIONS: For PPV, MAC adjusted balanced anaesthesia using a laryngeal mask without neuromuscular blockade was associated with more, but clinically irrelevant upward eye deviations and may be an alternative to intubation with neuromuscular blockade. However, adequate depth of anaesthesia must be assured to avoid unwanted injuries during surgery.


KEY WORDS: PPV, immobilisation, muscle relaxation, intubation, laryngeal mask

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Publication History

Article first published online: October 12, 2017
Manuscript accepted: October 10, 2017
Manuscript revised: September 14, 2017
Manuscript received: July 3, 2017

Per citare questo articolo

Fudickar A, Gruenewald M, Fudickar B, Hill M, Wallenfang M, Hüllemann J, et al. Immobilisation during anaesthesia for vitrectomy using a laryngeal mask without neuromuscular blockade versus endotracheal intubation and neuromuscular blockade. Minerva Anestesiol 2017 Oct 12. DOI: 10.23736/S0375-9393.17.12282-0

Corresponding author e-mail

axel.fudickar@uksh.de