Asleep-awake-asleep technique in children during strabismus surgery under sufentanil balanced anesthesia

Both over- and undercorrection can occur in up to 10-15% of strabismus surgeries. Use of adjustable suture technique and an intraoperative awake test may decrease the incidence of over- or undercorrection. In this study, we investigated the ability to provide optimal conditions for intraoperative awake strabismus suture adjustment in children by means of target-controlled infusions (TCI) of propofol and remifentanil propofol compared with propofol and sufentanil.

Forty-six ASA I-II patients undergoing strabismus surgery with intraoperative awakening were randomly assigned to anesthesia by TCI of propofol + sufentanil group (group SF) or propofol + remifentanil spontaneous breathing. Propofol was discontinued, and concentrations of the opioid TCIs were reduced to enable awake assessment of the mobility and position of the eye. Changes in intraocular pressure, respiratory function, hemodynamics, awakening time, and awaking quality were compared between the two groups. The degrees of sedation and analgesia were evaluated through the assessment of alertness and sedation scores (OAA/S) and visual analog scale scores (VAS).

There was no significant difference in intraocular pressure at three sampling points between two groups (P > 0.05). The heart rate (HR) and mean arterial blood pressure (MAP) in group SF were significantly lower than group RF during laryngeal mask insertion (P < 0.05) as well as during the wake-up test (P < 0.05). Spontaneous breathing was maintained in all patients, and there was no significant difference in RR and Sp02 at T1-T11 between the groups (P > 0.05). There was no significant difference in the target effect-site concentration of propofol at T1-T10 between the groups (P > 0.05). The wake-up times in group SF were significantly longer than in group RF (P < 0.05). In contrast, the quality of wake-up test and the degree of consciousness after the patients were awakened were significantly better (19 good and 4 satisfactory vs 15 good, 2 satisfactory, and 6 poor) in SF group than RF group. The VAS was significantly lower at T6-T9 in SF group than in RF group (P < 0.05). The incidence of untoward events during and after surgery, such as respiratory depression and apnea, oculocardiac reflex, coughing, groan and nausea, and vomiting was not significantly different between the groups (P > 0.05).

Propofol combined with sufentanil or remifentanil can be suitable for planned intraoperative awakening for an adjustable suture technique in pediatric patients during strabismus surgery. Remifentanil has quicker wake-up time; however, sufentanil demonstrated an advantage in terms of better analgesia, more stable hemodynamics, and improved qualify of awakening.