Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
권호 표지
DOI QR코드

DOI QR Code

Suddenly fixed upward ocular deviation under general anesthesia

  • Kim, Won Jae (Department of Ophthalmology, Yeungnam University College of Medicine) ;
  • Park, Sang-Jin (Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine) ;
  • Kim, Myung Mi (Department of Ophthalmology, Yeungnam University College of Medicine)
  • Received : 2017.03.06
  • Accepted : 2017.04.04
  • Published : 2017.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Various changes in ocular position are possible during general anesthesia as opposed to the awakening state. However, unexpected ocular deviation under general anesthesia is a disconcerting event as it can lead to difficult complications intraoperatively. To date, sudden fixed upward ocular deviation has been rarely reported previously. This phenomenon was observed in an 8-year-old boy during strabismus surgery. Suddenly fixed upward ocular deviation occurred when the speculum was inserted into the right eye. When the eyeball was pulled down, using forceps, there was some resistance, such as contracture of superior rectus. The eyeball sprang back into the upward position when the forceps was released. These changes could hamper the good exposition of the surgical field, leading to significant intraoperative difficulties and complications. Surgeons should be aware of this possibility, despite general anesthesia; if it occurs, proceed with the surgery as planned preoperatively, and both ophthalmic and anesthetic interventions should be used to solve this problem.

Keywords

References

  1. Ohmi E, Ogli K, Kani K. Eye position and electromyographic observation of squint eyes under general anesthesia. Ophthalmologica 1979;178:166-71. https://doi.org/10.1159/000308817
  2. Apt L, Isenberg S. Eye position of strabismus patients under general anesthesia. Am J Ophthalmol 1977;84:574-9. https://doi.org/10.1016/0002-9394(77)90455-X
  3. Daien V, Turpin C, Lignereux F, Belghobsi R, Le Meur G, Lebranchu P, et al. Determinants of ocular deviation in esotropic subjects under general anesthesia. J Pediatr Ophthalmol Strabismus 2013;50:155-60. https://doi.org/10.3928/01913913-20130226-01
  4. Mims JL 3rd. "Double elevator palsy" eye supraducts during stage II general anesthesia supporting hypothesis of (supra) nuclear etiology. Binocul Vis Strabismus Q 2005;20:199-204.
  5. Rossiter JD, Wood M, Lockwood A, Lewis K. Operating conditions for ocular surgery under general anaesthesia: an eccentric problem. Eye (Lond) 2006;20:55-8. https://doi.org/10.1038/sj.eye.6701789
  6. Wright KW, Strube YNJ. Pediatric ophthalmology and strabismus. 3rd ed. Oxford: Oxford University Press, 2012. p. 317-20.
  7. Ortega A, Sarobe C, Iribarren MJ, Giraldez J. Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium. Pharm World Sci 2000;22:82-7. https://doi.org/10.1023/A:1008737332389