title: Combined propofol sedation with sub-Tenon's lidocaine/mercaine infusion for strabismus surgery in adults.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of propofol sedation combined with sub-Tenon's anaesthesia for strabismus surgery in adults.
  
  
  METHODS
  Thirty-two consecutive patients aged 31-85 years underwent strabismus surgery under general (n=16) or local (n=16) anaesthesia. In the local anaesthesia (study) group, sedation was induced with a loading dose of midazolam, fentanyl, and propofol, followed by continuous infusion of propofol, 3-6 mg/k/h to deep sedation. A nasal tube was inserted to prevent airway obstruction. Sub-Tenon's anaesthesia included infusion of a 3-4 ml mixture (50 : 50) of lidocaine 2%/mercaine 0.5%. General anaesthesia consisted of premedication with midazolam, followed by fentanyl, esmeron-bromate, propofol, and tracheal intubation. Duration of surgery and anaesthesia, intraoperative oculocardiac reflex and arrhythmias, time to discharge, postoperative pain, nausea and vomiting, and patient and surgeon satisfaction were evaluated.
  
  
  RESULTS
  The local anaesthesia group had a significantly shorter operative and anaesthesia time, fewer episodes of oculocardiac reflex or arrythmia/bradycardia requiring treatment, fewer early or late episodes of nausea and vomiting, and less pain. The patients and surgeon in this group reported higher satisfaction.
  
  
  CONCLUSIONS
  Propofol sedation with local sub-Tenon's injection of lidocaine/mercaine is recommended for the induction and maintenance of anaesthesia during unilateral or bilateral strabismus surgery in adults. The method is quick and effective, without systemic or ocular side effects.
authors.affiliation: Pediatric Ophthalmology and Strabismus Unit, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel. moshesnir@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Snir
authors.forename: M
authors.initials: M
authors.lastname: Bachar
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.forename: R
authors.initials: R
authors.lastname: Friling
authors.forename: D
authors.initials: D
authors.lastname: Weinberger
authors.forename: R
authors.initials: R
authors.lastname: Axer-Siegel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage; D001291:Attitude of Health Personnel; D002045:Bupivacaine / Q000008:administration & dosage; D054810:Deep Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007432:Intraoperative Period; D007902:Length of Stay; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011183:Postoperative Complications; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D015742:Propofol; D013285:Strabismus / Q000601:surgery*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine; D015742:Propofol