Novel technique for positioning children under general anesthesia for ophthalmic YAG laser capsulotomy using the Hug-U-V
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CORRESPONDENCE
Novel technique for positioning children under general anesthesia for ophthalmic YAG laser capsulotomy using the Hug-U-VacÒ surgical positioning system Elizabeth Y. Lee, MD . Desigen Reddy, MD, FRCSC . Kourosh Sabri, MD, FRCSC
Received: 18 June 2020 / Revised: 16 July 2020 / Accepted: 17 July 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, Posterior capsular opacification (PCO) is a common complication after cataract surgery in children1 and is commonly described as ‘‘scar tissue.’’ If left untreated, it can cause permanent vision loss in children. Its treatment includes an Nd:YAG laser capsulotomy to create an opening in the thickened posterior capsule. While in adults this procedure can be done in an awake state, children require general anesthesia (GA). The reasons include the significantly greater amount of laser shots required in children and the importance of head stability during the procedure. We reportA a case series where a ‘‘bean bag’’-type AllenÒ Hug-U-VacÒ surgical positioning system (Allen Medical; Acton, MA, USA) was used for positioning children in a seated position under GA. Eleven children with PCO after cataract surgery underwent laser capsulotomy under GA between 3 April 2017 and 25 November 2019. The ages of the six male and five female patients ranged from 3 and 12 yr (median, 7 yr) with weights between 17 kg and 61 kg (median, 20 kg). An anesthetic technique of parental presence at induction, inhalational induction, intravenous (IV) placement, IV supplementation with propofol, remifentanil, oral intubation, maintenance with sevoflurane, anti-emetic prophylaxis, fentanyl, and
E. Y. Lee, MD K. Sabri, MD, FRCSC (&) Department of Ophthalmology, McMaster University, Hamilton, ON, Canada e-mail: [email protected] D. Reddy, MD, FRCSC Department of Anesthesiology, McMaster University, Hamilton, ON, Canada
standard monitoring was used. The patients were then positioned and the air was evacuated from the bean bag that had been placed under the patient prior to GA (Figure A). The patient’s head was then placed on the chin rest of the Nd:YAG laser and taped to the forehead rest for stability (Figure B). All contact points between the patient and the laser were cushioned to decrease pressure points. The mean (standard deviation) time for induction of GA was 12.9 (5.3) min. The positioning and laser treatment took 25.1 (10.5) min (range, 15–49 min). There were no anesthetic or ocular complications during the procedure for any of the cases. Several methods of positioning children for laser capsulotomy under GA have previously been reported.2 A major concern with lateral decubitus positioning is that the bed has to be raised to maximum height with safety mechanisms such as operating room bed risers removed to fit the laser in proper position.3 Safety concerns in a case series report of three patients positioned prone with hyperextension of the neck to fit the patient’s head on the chin rest included excessive pressure on dependent areas, and temporary disconnection of
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