Possibilities of using regional anesthesia with diode-laser transscleral cyclophotocoagulation in children: description of clinical cases

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Abstract

BACKGROUND: Diode-laser transscleral cyclophotocoagulation (DLTCPC) is one of the most commonly used treatment options for intraocular pressure reduction in refractory glaucoma in adult and pediatric patients. To achieve the necessary effect, these operations often have to be repeated. Repeated general anesthesia inductions increase the risk of cognitive disorders in children and sometimes do not provide sufficient postoperative analgesia.

OBJECTIVE: To analyze the results of transscleral DLTCPC in children under regional anesthesia and identify factors predisposing to the choice of this anesthesia method.

MATERIALS AND METHODS: The study included 33 children aged 10–17 years who had undergone 57 transscleral DLTCPCs in IRTC Eye Microsurgery Ekaterinburg Center between 01.09.2017 to 31.08.2022. In each case, the anesthesia method was selected individually according to the principle of reasonable sufficiency.

RESULTS: Of 57 operations, 36 (73%) were performed under regional and 21 (37%) were under general anesthesia. Factors that favor regional anesthesia include (1) psycho-emotional maturity of the patient, (2) older age, and (3) greater number of previous operations. An algorithm for the selection of the anesthesia method is presented, as well as a plan for the conversation with the patient and his / her legal representatives. Regional anesthesia provides good intra- and postoperative anesthesia and prophylaxis of postoperative cognitive disorders in children who are emotionally stable and suitable for this type of anesthesia.

CONCLUSION: Considering the psycho-emotional features of children, general anesthesia remains the main method in ophthalmic anesthesiology. Nevertheless, following the principle of reasonable sufficiency and accounting for the short duration of DLTCPC and the large extent of general anesthesia survived by these children previously, regional anesthesia can be successfully used in a portion of these children.

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About the authors

Sergei V. Bersenev

Ekaterinburg Center of IRTC «Eye Microsurgery»

Author for correspondence.
Email: serg_bersenev@mail.ru
ORCID iD: 0009-0004-9246-8969
SPIN-code: 6143-7472

MD, Cand. Sci. (Med.)

Russian Federation, Ekaterinburg

Julia M. Konyaeva

Ekaterinburg Center of IRTC «Eye Microsurgery»

Email: Juliakis@icloud.com
ORCID iD: 0009-0005-2938-4575
SPIN-code: 9886-2000
Russian Federation, Ekaterinburg

Olga M. Yurchenko

Ekaterinburg Center of IRTC «Eye Microsurgery»

Email: Bagi6@mail.ru
ORCID iD: 0009-0001-8840-6923
SPIN-code: 8293-3819
Russian Federation, Ekaterinburg

References

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Supplementary files

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2. Fig. 1. The principle of reasonable sufficiency.Note. КОБ — pterygopalatine-orbital blockade, ЛМ — laryngeal mask, I-GEL — second generation disposable supraglottic airway.

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3. Fig. 2. Children who underwent more than 1 diode laser transscleral cyclophotocoagulation from 2017 to 2022.

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