Ophthalmic Procedures Research Articles

Vertical enlargement of the palpebral aperture by surgical modification of the lower eyelid: A new cosmetic option for Chinese patients

The distinctive features of Oriental eyes are narrow palpebral aperture and upslanting lower eyelid margin, which are not in accordance with modern appreciation of beauty. Although many ophthalmic plastic procedures have been designed to change the characteristic appearance, the methods to enlarge the palpebral aperture by lowering the lower eyelid are limited. A total of 63 Chinese patients received the lowering the lower eyelid procedure from April 2014 to August 2018. The main criteria are patients who have vertically narrow palpebral aperture with or without upslanting lower eyelid shape. But patients who have proptosis or unhealthy lower eyelid elasticity are not suitable for this procedure. The operation is performed by suturing the lower tarsal plate and the infraorbital periosteum together, adjusting the tension of knots to reach the patient's desire for the shape of lower eyelid margin, and finally tightening all the knots. The lateral lower eyelid margin was lowered and the lateral part of the palpebral aperture was enlarged in all cases (P<0.01). Only five patients (7.9%) were not fully satisfied because of the partial retraction of the lateral eyelid margin. Minor complications were observed, of which conjunctival chemosis in three patients (4.8%) and conjunctival hemorrhage in two patients (3.2%). Lowering the lower eyelid procedure is an effective and safe approach for patients who desire to smooth the upslanting shape and enlarge the eyes. The strict criteria and careful preoperative evaluations are critical to avoid complications and achieve good outcomes for Chinese patients.

COVID-19 and ophthalmology: An environmental work hazard.

COVID-19 and ophthalmology: An environmental work hazard.

Evaluation of Effects of Uncomplicated Cataract Surgery on Intraocular Pressure

Cataract surgery is the most commonly performed ophthalmic surgical procedure of any kind, and the use of phacoemulsification to remove the cataract is increasingly becoming the standard of care worldwide.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Review of SARS-CoV-2 and Conjunctivitis: Ophthalmologists Be Safe

The COVID-19 or the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) has become pandemic with its origin in Wuhan, city of China. Within few weeks, it became a global health threat involving more than 200 countries. Though the main route of transmission is by respiratory droplets; trans-conjunctival aerosol infection is a known mode of disease transmission. Patients with COVID-19 conjunctivitis have the transmissible virus in the tears. Close contact during ophthalmic procedures poses the risk of patient to ophthalmologist disease transmission. Conjunctivitis may be the first symptom of COVID-19. In context to this and the close proximity of an ophthalmologist and Health Care Workers (HCW) with the patient, and the nature of work, standard infection protection measures guidelines have been given by prominent healthcare societies.

Incidence of post-operative nausea and vomiting and its associated factors following pediatric ophthalmic surgery at University of Gondar Comprehensive Specialized Hospital, 2019

BackgroundPostoperative nausea and vomiting is still viewed as minor problems, even though they are one of the major causes of morbidity in pediatric surgical patients like surgical site bleeding, pulmonary aspiration of gastric contents, fluid and electrolyte disturbances and dehydration, delayed hospital discharge, unexpected hospital admission and decreased patient satisfaction and cost. Surgical, anesthetic related factors as well as patient factors are major contributing factors for PONV. PurposeThe objective of this study was to assess Incidence of post-operative nausea and vomiting and factors associated with vomiting after pediatrics ophthalmic procedure under GA. Designprospective cross sectional study. MethodsInstitutional based prospective observational study was conducted to determine Incidence of post-operative nausea and vomiting and its associated factors. Data were checked on daily basis for completeness and were entered to Epi info and analyzed using statistical package for social sciences (SPSS) version 20 software. FindingsThe overall incidence of post-operative vomiting in pediatrics ophthalmic procedure under GA was 19.9% (CI = 14.5–25.3%). Factors associated with post-operative vomiting were age>3years, motion sickness and duration of surgery >30min. ConclusionThe incidence of post-operative vomiting after pediatrics ophthalmic procedure was 19.9%. Age>3years, motion sickness and duration of surgery >30 min were significantly associated with post-operative vomiting.

Ophthalmic features and management outcomes of 30 children having Goldenhar syndrome.

To study the ophthalmic clinical profile and the management outcomes of children having Goldenhar syndrome (GS). Retrospective review of included children fulfilling the diagnostic criteria of GS was performed. The demography, ophthalmic features, systemic anomalies, and treatment outcomes were recorded manually from patient files. An ENT, pediatrics, cardiology, and orthopedics consultation was sought for all GS patients before taking up for any ophthalmic surgical procedure. The anatomical (ocular surface and eyelid) and functional {vision and extraocular movements (EOM)} factors were exclusively studied. We ensured a minimum postoperative follow-up of 12months, and our data were compared with the major studies featuring 'ophthalmic features' of GS. Totally 30 children (females = 18, 60%) were included with a median presenting age of 48months. Twenty-seven (90%) had unilateral ophthalmic involvement with major features being upper eyelid coloboma (n = 25, 75.76%), lipodermoid (n = 18, 54.55%), and limbal dermoid (n = 10, 30.3%). Diminution of visual acuity was recorded in 22 (73.3%), while five (16.7%) had limitation of EOM. Systemically, the prominent features included hemifacial hypotrophy (100%), auricular anomalies (80%), cardiac anomalies (10%), and scoliosis (6.67%). The eyelid colobomas were repaired with the direct closure ± cantholysis technique or using a Tenzel's flap. All children had satisfactory anatomical and functional outcomes after ophthalmic surgical interventions without any significant complications. The tailored ophthalmic surgical intervention(s) provides satisfactory restoration of anatomy and functionality of the eye. These children need specific multi-discipline consultations for the holistic management and complete care.

Intraocular calcidiol: Uncovering a role for vitamin D in the eye

Vitamin D has emerged as a potentially important molecule in ophthalmology. To date, all ophthalmic data pertaining to vitamin D has been restricted primarily to tear and serum analysis in human patients. Considering the isolated nature of the eye, we sought to determine the presence of intraocular vitamin D in ocular disease. Methods25-Hydroxyvitamin D3 (25(OH)D3) concentrations were measured in the eye and blood of 120 participants undergoing ophthalmic procedures. Ocular localization of the 1,25-dihydroxyvitamin D3-generating (CYP27B1) and deactivating (CYP24A1) hydroxylases was performed by immunohistochemistry. Gene expression of CYP27B1, CYP24A1 and VEGF-A was measured in eyes from patients with and without disease. Results25(OH)D3 was quantified in 112 ocular samples. In 40 cataract patient samples, the average 25(OH)D3 concentration was 0.057 ng/mL, compared to 72 retinal disease patient samples, average of 0.502 ng/mL (p < 0.001). Intraocular 25(OH)D3 did not correlate with serum levels of 25(OH)D3. There was no difference between the level of 25(OH)D3 measured in the aqueous and vitreous humour. The vitamin D-specific CYPs 27B1 and 24A1, strongly localized to complementary regions of the ciliary body, retinal pigment epithelium and neural retina. Gene expression analysis confirmed retinal CYP27B1 correlated strongly with VEGF-A in eyes from diabetic patients (r = 0.92, p < 0.001). ConclusionsOur data confirms that vitamin D is present in the humours of the human eye and that local synthesis/degradation is possible via the ocular CYP27B1 and CYP24A1. This argues for a functional role for local vitamin D production and signaling in the eye and suggests that vitamin D may be an important intraocular mediator in disease pathogenesis.

Preoperative topical liposomal ozone dispersion to reduce bacterial colonization in conjunctival sac and periocular skin: Preliminary study in dogs

Prophylaxis represents a keystone to reduce periocular skin and ocular conjunctiva bacterial load before surgical procedures. Despite many prophylactic agents are available the preferred perioperative ocular surface antimicrobial is still unknown. The purpose of this study was to assess the effectiveness of preoperative liposomal ozone dispersion in reducing bacterial colonization from the conjunctival sac and periocular skin in dogs, in comparison with povidone-iodine and fluoroquinolone. Twenty-two owned dogs consisting with 44 eyes in total scheduled for ophthalmic surgical procedure were enrolled for the study and divided in four groups receiving either ozone dispersion or povidone iodine in eyelid and conjunctiva, fluoroquinolone or placebo. A swab was taken before and after the antisepsis protocol evaluating total microbial count, coagulase positive and negative staphylococci. Statistical analysis revealed a significant decrease in colony forming units (CFU) for total microbial count, coagulase positive and negative staphylococci both for liposomal ozone dispersion and povidone iodine. No statistical differences were detected in median CFU for both one-day placebo and fluoroquinolone preoperative prophylactic topical therapy. The results of this preliminary study demonstrate that liposomal ozone-dispersion is as effective as povidone iodine to reduce preoperative bacterial load in ocular surface.

Does general anesthesia or intravitreal injection affect neurodevelopment in children undergoing ophthalmic procedures?

To review recent studies on potential neurodevelopmental impacts on the pediatric population through general anesthesia events or intravitreal anti-vascular endothelial growth factor (VEGF) injection. Studies on this topic have been extensive with varied reported neurodevelopmental outcomes. Initial investigations in rodents and primates showed negative impact of anesthetics on neurodevelopment. Subsequent retrospective human reviews had mixed results whereas more recent sibling and prospective studies have been published without evidence of clinically significant impact. A similar narrative has more recently come to play regarding the long-term effects of intravitreal injections used in neonates with retinopathy of prematurity. Publications initially indicated a negative correlation whereas later reviews have found no difference between those receiving injections versus laser treatment. Given that recent data on both general anesthesia events and intravitreal anti-VEGF injections do not show a long-term negative neurodevelopmental impact, ocular procedures needed to improve a pediatric patient's vision or quality of life should not be delayed.

Endophthalmitis after Cataract Surgery in the United States: A Report from the Intelligent Research in Sight Registry, 2013–2017

To determine recent incidence and visual outcomes for acute-onset endophthalmitis after cataract surgery performed in the United States. Retrospective cohort study. United States cataract surgery patients, 2013-2017 (5 401 686 patients). Cases of acute-onset postoperative endophthalmitis occurring within 30 days after cataract surgery were identified using diagnosis codes in the American Academy of Ophthalmology IRIS (Intelligent Research in Sight) Registry database, drawn from electronic health records in ophthalmology practices across the nation. Annual and aggregate 5-year incidences were determined for all cataract surgeries andspecifically for standalone procedures versus those combined with other ophthalmic surgeries. Patientcharacteristics were compared. Mean and median visual acuity was determined at 1 month preoperative aswell as 1 week, 1 month, and 3 months postoperative among patients with and without endophthalmitis. Incidence of acute-onset postoperative endophthalmitis after cataract surgery. A total of 8 542 838 eyes underwent cataract surgery, 3629 of which developed acute-onset endophthalmitis (0.04%; 95% confidence interval, 0.04%-0.04%). Endophthalmitis incidence was highest among patients aged 0 to 17 years (0.37% over 5 years), followed by patients aged 18 to 44 years (0.18% over 5 years; P < 0.0001). Endophthalmitis occurred 4 times more often after combined cases (cataract with other ophthalmic procedures) than after standalone cataract surgeries (0.20% vs. 0.04% of cases), and occurred in 0.35% of patients receiving anterior vitrectomy. Mean 3-month postoperative visual acuity was 20/100 (median, 20/50) among endophthalmitis patients, versus a mean of approximately 20/40 (median, 20/30) among patients without endophthalmitis. However, 4% of endophthalmitis patients still achieved 20/20 or better visual acuity, and 44% achieved 20/40 or better visual acuity at 3 months. Acute-onset endophthalmitis occurred in 0.04% of 8 542 838 cataract surgeries performed in the United States between 2013 and 2017. Risk factors may include younger age, cataract surgery combined with other ophthalmic surgeries, and anterior vitrectomy. Visual acuity outcomes vary; however, patients can recover excellent vision after surgery. Big data from clinical registries like the IRIS Registry has great potential for evaluating rare conditions such as endophthalmitis, including developing benchmarks, longer-term time trend investigation, and comprehensive analysis of risk factors and prophylaxis.

Surgical Confusions in Ophthalmology: Description, Analysis, and Prevention of Errors from 2006 through 2017

To characterize surgical confusions in ophthalmology to determine their incidence, root causes, and impact on patients and physicians. Retrospective cohort study of errors in ophthalmic surgical procedures between January 1, 2006, and December 31,2017. One hundred forty-three cases involving surgical confusions. Cases were identified by the Ophthalmic Mutual Insurance Company from closed case files and by the New York State Health Department from the New York Patient Occurrence Reporting and Tracking program that identified the surgical confusions. Incidence and impact by intended surgery, error type, and root cause as well as preventability by the Universal Protocol. Of the 143 cases of surgical confusions identified, 92 cases (64.3%) were deemed preventable by the Universal Protocol. Approximately two thirds, 95 cases (66.4%), were cases of incorrect implants being used during cataract surgery (cataract extraction and intraocular lens implantation), of which 33 cases (34.7%) were not preventable by the Universal Protocol. Wrong eye blocks or anesthesia accounted for 20 cases (14.0%), incorrect eye procedures accounted for 10 cases (7.00%), incorrect refractive surgery measurements accounted for 6 cases (4.20%), incorrect patient or procedure accounted for 5 cases (3.50%), incorrect intraocular gas concentration accounted for 4 cases (2.80%), and incorrect medication in surgery accounted for 3 cases (2.10%). The most common root cause of confusion was an inadequately performed time out, which was responsible for nearly one third of all surgical confusions, 46 cases (32.2%). Incorrect lens orders or calculations before surgery (so-called upstream errors) were the second most common cause of surgical confusion, involving 31 cases (21.7%). The average legal indemnity for incorrect implant during cataract surgery was $57 514 (United States dollars). The average indemnity for incorrect refractive surgery measurement was $123 125, that for incorrect eye procedure was $50 000, and that for incorrect gas concentration was $220 844. Most surgical confusions could have been prevented by following the Universal Protocol properly. However, upstream errors, originating in the clinic or office before surgery, and ineffective communication during time outs suggest a need for modification of the Universal Protocol.

Economic burden of diabetes in Brazil in 2014

BackgroundDiabetes and its complications produce significant clinical, economic and social impact. The knowledge of the costs of diabetes generates subsidies to maintain the financial sustainability of public health and social security systems, guiding research and health care priorities.AimsThe aim of this study was to estimate the economic burden of diabetes in Brazilian adults in 2014, considering the perspectives of the public health care system and the society.MethodsA prevalence-based approach was used to estimate the annual health resource utilization and costs attributable to diabetes and related conditions. The healthcare system perspective considered direct medical costs related to outpatient and hospitalization costs. The societal perspective considered non-medical (transportation and dietary products) and indirect costs (productivity loss, disability, and premature retirement). Outpatient costs included medicines, health professional visits, exams, home glucose monitoring, ophthalmic procedures, and costs related to end stage renal disease. The costs of hospitalization attributed to diabetes related conditions were estimated using attributable risk methodology. Costs were estimated in Brazilian currency, and then converted to international dollars (2014).ResultsBased on a national self-reported prevalence of 6.2%, the total cost of diabetes in 2014 was Int$ 15.67 billion, including Int$ 6.89 billion in direct medical costs (44%), Int$ 3.69 billion in non-medical costs (23.6%) and Int$ 5.07 billion in indirect costs (32.4%). Outpatient costs summed Int$ 6.62 billion and the costs of 314,334 hospitalizations attributed to diabetes and related conditions was Int$ 264.9 million. Most hospitalizations were due to cardiovascular diseases (47.9%), followed by diabetes itself (18%), and renal diseases (13.6%). Diet and transportation costs were estimated at Int$ 3.2 billion and Int$ 462.3 million, respectively.ConclusionsOur results showed a substantial economic burden of diabetes in Brazil, and most likely are underrated as they are based on an underestimated prevalence of diabetes. Healthcare policies aiming at diabetes prevention and control are urgently sought.

Diagnostic Quality Assessment of Ocular Fundus Photographs: Efficacy of Structure-Preserving ScatNet Features.

Various ophthalmic procedures critically depend on high-quality images. For instance, efficiency of teleophthalmology, a framework to bring advanced eye care to remote regions, is determined by the capability of assessing diagnostic quality of ocular fundus photographs (FPs), and rejecting poor-quality ones at the source. In this context, we study algorithmic methods of classifying high- and low-quality FPs. Crucially, diagnostic quality (DQ) - determined by clinically, but not necessarily perceptually, significant structures - is not synonymous with perceptual appeal. Yet, traditional methods handpick features individually (or in small subsets) to meet certain ad hoc perceptual requirements. In contrast, we investigate the efficacy of a comprehensive set of structure-preserving features, systematically generated by a deep scattering network (ScatNet). Specifically, we consider three advanced machine learning classifiers, train each using ScatNet as well as traditional features separately, and demonstrate that the former ensure significantly superior performance for each classifier under multiple criteria including classification accuracy.

Surgical casuistic in dogs at a Veterinary Hospital - Piauí State Federal University

The objective of this report was to record surgical procedures performed in 241 dogs in a teaching veterinary hospital. There were 40 elective surgical procedures (16.6%) and 201 therapeutic surgical procedures (83.4%). The most frequent procedure was ovariohysterectomy (OH), 65% (26/40) and 24.38% (49/201), respectively, for elective and therapeutic surgical procedures. Among therapeutic surgical procedures were registered fracture reduction (16.91%, 34/201), mastectomies (13.93%, 28/201), drainage of the otohematoma (12.94%; 26/201) and ophthalmic surgical procedures (5.47%, 11/201). The high percentage of therapeutic surgical procedures conducted demonstrates the complexity of the cases attended daily in a teaching veterinary hospital.

Epidemiology of primary ophthalmic procedures performed in the United States

ObjectiveTo determine and compare epidemiology, patient demographics, and socioeconomic factors of ophthalmic procedures in the United States. ParticipantsAll ophthalmic ambulatory procedures performed from 2012 to 2014. MethodsThe State Ambulatory Surgery Databases (SASD), a collection of data from 29 participating states that represent two-thirds of the U.S. population, were used for analysis. All ophthalmic procedures performed in ambulatory settings from 2012 to 2014 were included. Incidence and demographics for each procedure were assessed, with descriptive statistics determined to highlight key differences in epidemiology and patient characteristics for each procedure. Population-based rates of procedures for each racial group were calculated using national census data. ResultsOver a period of 3 years, 3 934 004 ophthalmic procedures were performed, with majority being ambulatory (98.5%). Most common procedures were lens and cataract removal (66.5%), followed by intraocular procedures (11.4%) and procedures involving eyelids, cornea, and conjunctiva (8.2%). All ambulatory procedures had a higher number of female patients except retinal tear and detachment repairs (male patients, 59.4%). Most procedures had a higher rate in blacks compared with whites and other races, and Medicare was the most common mode of payment. ConclusionsApproximately 1.3 million ambulatory ophthalmic procedures were performed every year between 2012 and 2014 in the 29 reporting states of the United States. Low-income groups and certain minorities, apart from blacks, having a lower rate of procedure suggest that disparities exist in provision of eye care. The factors leading to these differences need to be further studied in order to devise strategies to provide equitable care.

The Management of Childhood Intracranial Tumours and the Role of the Ophthalmologist

ABSTRACTObjective: This study looked at a single paediatric neuro-oncology centre’s experience of childhood intracranial tumours seen in the ophthalmology clinic over an approximately five-year period. This was used to analyse the role of the ophthalmologist in their long term follow up.Methods: A database was compiled of all children discussed at the neuro-oncology multi-disciplinary team (MDT) meeting between January 2012 and April 2017. All children who had an intracranial tumour determined by histology or suspected on neuro-imaging, who had also been seen in the ophthalmology clinic, were included. A retrospective case review was performed to create a record for each child.Results: The database contained 129 children of which 82 (64%) were boys and 47 (36%) were girls. Of these 89 (69%) had a histological diagnosis and 40 (31%) had a tumour suspected on neuroimaging. The most common tumour locations were the posterior fossa (n = 54, 42%), diencephalon (n = 20, 16%) and the visual pathways (n = 17, 13%). Papilloedema at first presentation was only found in 39 (30%) children. The most common other neuro-ophthalmic manifestations were non-paralytic strabismus (n=33), sixth nerve palsy (n=19) and seventh nerve palsy (n=12). Non-paralytic strabismus was a presenting symptom in only one case. There were 13 ophthalmic surgical procedures required for these children, the most common being strabismus surgery.Conclusion: We report the types and locations of paediatric intracranial tumours seen in the ophthalmology clinic as well as their neuro-ophthalmic manifestations. Only 30% presented with papilloedema and approximately 10% required an ophthalmic surgical procedure.

Determinants of Radiation Dose in Selective Ophthalmic Artery Chemosurgery for Retinoblastoma.

Retinoblastoma is the most common pediatric ocular neoplasm. Multimodality treatment approaches are commonplace, and selective ophthalmic artery chemosurgery has emerged as a safe and effective treatment in selected patients. Minimizing radiation dose in this highly radiosensitive patient cohort is critical. We explore which procedural factors affect the radiation dose in a single-center cohort of children managed in the UK National Retinoblastoma Service. A retrospective review was performed of 177 selective ophthalmic artery chemosurgery procedures in 48 patients with retinoblastoma (2013-2017). Medical records, angiographic imaging, and radiation dosimetry data (including total fluoroscopic screening time, skin dose, and dose-area product) were reviewed. The mean fluoroscopic time was 13.5 ± 13 minutes, the mean dose-area product was 11.7 ± 9.7 Gy.cm2, and the mean total skin dose was 260.9 ± 211.6 mGy. One hundred sixty-three of 177 procedures (92.1%) were technically successful. In 14 (7.9%), the initial attempt was unsuccessful (successful in 13/14 re-attempts). Screening time and radiation dose were associated with drug-delivery microcatheter location and patient age; screening time was associated with treatment cycle. In selective ophthalmic artery chemosurgery, a microcatheter tip position in the proximal or ostial ophthalmic artery and patient age 2 years or younger were associated with reduced fluoroscopic screening time and radiation dose; treatment beyond the first cycle was associated with reduced fluoroscopic screening time.

Sever inadvertent globe perforation during supplemental peribulbar anesthesia injection

A globe perforation is a well-known serious complication during peribulbar anesthesia. A second supplement injection may further increase the risk of this complication. Retrobulbar hemorrhage and brainstem injection are other serious complications have been reported following peribulbar injections. Although there is an increasing popularity for needle-free procedures of local anesthesia such as sub-tenon's injection and topical anesthesia, peribulbar anesthesia remains one of the favorite techniques for providing anesthesia in ophthalmic procedures. The risk for inadvertent globe perforation is increased if the patient has long axial length or posterior staphyloma. However, careful attention should be done to all patients and not only those with risk factors for globe perforation. Here we report a 69-year-old male patient referred to vitreoretinal surgeon with a vitreous hemorrhage due to a sever globe perforation during peribulbar anesthesia, in which early diagnosis and management helped in achieving a good final visual outcome. Also, in this case we discussed the safety of peribulbar anesthesia supplements, and how to avoid such complication. Using of balloon compression for adequate time to spread the local anesthesia around the globe and giving the injection with a shorter needle syringe may reduce the risk for inadvertent globe perforation following a supplemental peribulbar anesthesia injection.

Comparison of low-fresh gas flow technique to standard technique of sevoflurane induction in children-A randomized controlled trial.

Although sevoflurane is preferred for inhalational induction in children, financial and environmental costs remain major limitations. The aim of this study was to determine if the use of low-fresh gas flow during inhalational induction with sevoflurane could significantly reduce agent consumption, without adversely affecting induction conditions. After institutional ethical committee approval, 50 children, aged 1-5years, undergoing ophthalmic procedures under general anesthesia, were randomized into two groups-standard induction (Group S) and low-flow induction (Group L). A pediatric circle system with 1L reservoir bag was primed with 8% sevoflurane in oxygen at 6Lmin-1 for 30seconds before beginning induction. In Group S, fresh gas flow was maintained at 6Lmin-1 until the end of induction. In Group L, fresh gas flow was reduced to 1Lmin-1 after applying facemask (time=T0). In both groups, sevoflurane was reduced to 5% after loss of eyelash reflex (T1). Once adequate depth of anesthesia was achieved (regular respiration, loss of muscle tone, and absence of movement to trapezius squeeze), intravenous access was secured (T2), followed by insertion of an appropriately sized LMA-Classic™ (T3). Heart rate and endtidal sevoflurane concentration were measured at each of the above time points, and at 15seconds following laryngeal mask airway insertion (T4). The total amount of sevoflurane consumed during induction was recorded. Sevoflurane consumption was significantly lower in Group L (4.17±0.70mL) compared to Group S (8.96±1.11mL) (mean difference 4.79 [95% CI=4.25-5.33] mL; P<0.001). Time to successful laryngeal mask airway insertion was similar in both groups. There were no significant differences in heart rate, incidence of reflex tachycardia, or need for rescue propofol. Induction of anesthesia with sevoflurane using low-fresh gas flow is effective in reducing sevoflurane consumption, without compromising induction time and conditions.