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Transition in eye gaze as a predictor of emergence from general anesthesia in children and adults: a prospective
Michiko Kinoshita1, Yoko Sakai2, Kimiko Katome2
1Department of Anesthesiology, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima-shi, Tokushima, 770-8503, Japan. michiko-kinoshita@tokushima-u.ac.jp.
Insights
Eye-gaze transition reliably indicates emergence from general anesthesia in children, appearing earlier than other responses. However, this neurological finding is not a useful indicator in adults.
Area of Science:
- Anesthesiology
- Neuroscience
- Pediatrics
Background:
- Monitoring eye movements during general anesthesia is valuable.
- Few studies investigate eye movement neurological findings during emergence from anesthesia maintained with short-acting opioids and volatile anesthetics.
Purpose of the Study:
- To examine neurological findings of the eyes during emergence from general anesthesia.
- To compare the timing of eye-gaze transition with other physical-behavioral responses in children and adults.
Main Methods:
- Thirty children (1-6 years) and 30 adults (20-79 years) received sevoflurane and remifentanil anesthesia.
- Recorded timing of eye-gaze transition, somatic movement, and respiration until spontaneous awakening.
- Analyzed incidence of eye-gaze transition and related physiological parameters.
Main Results:
- Eye-gaze transition occurred in 96.7% of children, significantly earlier than somatic movement or respiration.
- Only 10% of adults showed eye-gaze transition during emergence.
- The incidence of eye-gaze transition was significantly lower in adults compared to children.
Conclusions:
- Eye-gaze transition appears to be a reliable indicator of emergence from general anesthesia in children.
- Observation of eye gaze is not a useful indicator for emergence from anesthesia in adults.
Background:
It is useful to monitor eye movements during general anesthesia, but few studies have examined neurological finding of the eyes during emergence from general anesthesia maintained with short-acting opioids and volatile anesthetics.
Methods:
Thirty children aged 1-6 years and 30 adults aged 20-79 years were enrolled. Patients received general anesthesia maintained with sevoflurane and remifentanil. The timing of three physical-behavioral responses-eye-gaze transition (the cycle from conjugate to disconjugate and back to conjugate), resumption of somatic movement (limbs or body), and resumption of respiration-were recorded until spontaneous awakening. The primary outcome measure was the timing of the physical-behavioral responses. Secondary outcome measures were the incidence of eye-gaze transition, and the bispectral index, concentration of end-tidal sevoflurane, and heart rate at the timing of eye-gaze transition.
Results:
Eye-gaze transition was evident in 29 children (96.7%; 95% confidence interval, 82.8-99.9). After the end of surgery, eye-gaze transition was observed significantly earlier than resumption of somatic movement or respiration (472 [standard deviation 219] s, 723 [235] s, and 754 [232] s, respectively; p < 0.001). In adults, 3 cases (10%; 95% CI, 0.2-26.5) showed eye-gaze transition during emergence from anesthesia. The incidence of eye-gaze transition was significantly lower in adults than in children (p < 0.001).
Conclusion:
In children, eye-gaze transition was observed significantly earlier than other physical-behavioral responses during emergence from general anesthesia and seemed to reflect emergence from anesthesia. In contrast, observation of eye gaze was not a useful indicator of emergence from anesthesia in adults.
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