A prospective longitudinal study on the outcome of augmented conscious sedation in single-stage adjustable strabismus surgery.

Abstract

Introduction: Adjustable strabismus surgery offers surgeons the flexibility to refine outcomes postoperatively, with single-stage adjustable strabismus surgery (SSASS) allowing immediate adjustments facilitated by intravenous fentanyl and midazolam.

Purpose: Our study aims to study the efficacy of a specific drug combination for SSASS.

Methods: This prospective study enrolled 32 participants aged 14 years and older undergoing horizontal or inferior rectus muscle surgeries under anesthetist supervision. Premedication with ondansetron, glycopyrrolate, dexamethasone, tramadol, and ketorolac was done with sedation maintained using midazolam and fentanyl. Strabismus surgeries were conducted with monitoring of vital signs and hemodynamic parameters. Postoperative assessments were performed for one day and one month.

Results: Mean surgery duration was 1.1 ± 0.3 hours, with favorable mean intraoperative pain scores of 1.34 ± 0.9 and postoperative pain scores of 1.6 ± 0.9. No significant changes in hemodynamic parameters or postoperative vomiting were observed. However, substantial exotropic drift reduced success rates to 87.5% on the first postoperative day and 78.1% at one month.

Conclusion: Our findings demonstrate effective analgesia, hemodynamic stability, and surgeon comfort during SSASS with the studied drug combination. Ketorolac likely contributed to low postoperative pain scores, enabling conservative fentanyl dosing. Despite initial success in alignment, exotropic drift challenges long-term outcomes, suggesting a need for revised target angles in future studies to improve results.