Effectiveness and safety of low-dose vecuronium on globe position of pediatric patients in ocular surgery

Abstract

To test the effectiveness and safety of low-dose vecuronium (0.01 mg/kg) for correcting eccentric eye position during ocular surgery. A total of 80 ASA I-II children undergoing cataract or squint surgery were randomized into 2 groups (n = 40 each). Fentanyl and propofol were used for induction and then laryngeal mask (LMA) was inserted. 0.01 mg/kg vecuronium was administered to the low-dose group (L group) and 0.08 mg/kg vecuronium for high-dose group (H group). The ToF-Watch was fixed to monitor the train of four ratio (TOFR) of adductor pollicis. Eyeball eccentricity ratio before and after dosing, TOFR, duration of eyeball in central position, duration of surgery, the time from the end of surgery to removal of LMA and oculist satisfaction were recorded. The incidence of eccentric eyeball position was nearly 100% in both groups. The eyeball eccentricity ratio was 0.30 ± 0.11 in L group and 0.29 ± 0.12 in H group (P = 0.852) after/before vecuronium injection. The eyeballs were fixed well in the central position in both groups after vecuronium injection. The duration was shorter in L group than that in H group (23.43 ± 2.45 vs 37.63 ± 7.75 min, P < 0.001) . The time from the end of surgery to removal of LMA was (8.57 ± 3.49) min in L group and (12.28 ± 4.26) min in H group (P = 0.014). TOFR had merely mild reduction in L group and returned to normal in 10 minutes. At the end of surgery, TOFR was 102.43% ± 4.70% in L group and 80.47 ± 5.53 in H group (P < 0.001). Oculists were satisfied with eyeball position in both groups (P = 0.958). Low-dose vecuronium can correct eccentric eyeball position effectively and safely during ocular surgery while it has little effect on respiratory muscles.