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Improved method of dilating pupils for ophthalmic exams under anesthesia (faster and easier)
David H Abramson1,2, Todd Liu3, Edith Guarini1
1Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Insights
Adding Ketorolac to pre-procedure dilating drops for retinoblastoma patients significantly reduced anesthesia time. This four-drug combination for pupil dilation shortens procedures, benefiting children and staff.
Area of Science:
- Ophthalmology
- Anesthesiology
- Pediatric Oncology
Background:
- Pupil dilation is crucial for retinoblastoma examinations.
- Standard dilation drops (Tropicamide, Phenylephrine) are often ineffective once anesthesia begins.
- Pupil constriction under anesthesia prolongs examination time.
Purpose of the Study:
- To evaluate if adding Ketorolac to standard dilating drops shortens anesthesia duration for retinoblastoma procedures.
- To assess the efficacy of a four-drug combination for maintaining pupil dilation during anesthesia.
Main Methods:
- Retrospective analysis of retinoblastoma patients undergoing examination under anesthesia.
- Comparison of anesthesia duration between two groups: one receiving Tropicamide/Phenylephrine, the other receiving Tropicamide/Phenylephrine/Ketorolac/Proparacaine.
- Data collected from January 2019 to July 2023.
Main Results:
- The four-drug combination resulted in an average anesthesia time of 16 minutes, compared to 25 minutes for the two-drug combination.
- This represents a 36% reduction in anesthesia exposure time (9 minutes shorter).
- The difference was statistically significant (P < 0.001).
Conclusions:
- A four-drug combination drop (Tropicamide, Phenylephrine, Ketorolac, Proparacaine) significantly reduces anesthesia time for retinoblastoma exams.
- The enhanced dilation maintained under Sevoflurane anesthesia minimizes procedure duration.
- This approach offers substantial reductions in anesthesia exposure for children and staff, and reduces pre-anesthesia trauma.
Objective:
The pupils of children with retinoblastoma are routinely dilated pre-procedure with Tropicamide and Phenylephrine. Despite that, the pupil constricts once general anesthesia begins. The aim of this study is to see if adding Ketorolac to the regular dilating drops given pre-procedure shortens the length of anesthesia.
Methods:
Retrospective comparison of time under anesthesia for two groups of retinoblastoma children receiving anesthesia for examination under anesthesia: one group (January 1, 2019 to October 1, 2022) had been dilated with Tropicamide 1% and Phenylephrine 2.5% while the second group (October 2, 2022 to July 1, 2023) was dilated with a combination drop using those drugs with topical Ketorolac 0.5% and Proparacaine 0.5%.
Results:
Average anesthesia time for patients who received the older two-drug combination was 25 minutes vs. 16 minutes (36% reduction in exposure time) for those who received the newer four-drug combination (9 minutes less anesthesia) (P < 0.001).
Conclusions:
The use of a combined dilating drop that incorporated Tropicamide 1%, Phenylephrine 2.5%, Proparacaine 0.5% and Ketorolac 0.5% significantly shortened the time for exams under anesthesia for children with retinoblastoma because the pupil remained dilated after anesthesia induction with Sevoflurane. Using this combined drop, children will receive 5-10 hours less anesthesia during their treatment for retinoblastoma and staff will have more than 150 hours of fewer exposure to anesthetic gasses. In addition, far fewer drops are necessary pre-anesthesia, minimizing trauma to the children and families.
