Corneal abrasion risk in septorhinoplasty operations under general anesthesia

Year 2020, Volume: 3 Issue: 4, 427 - 431, 22.10.2020

Ali Bestemi Kepekçi , Ahmet Hamdi Kepekçi

https://doi.org/10.32322/jhsm.784750

Abstract

Aim: Proper care of the eye is required in all anesthetic applications, especially during general anesthesia. Corneal abrasion is the most common ophthalmologic complication in patients undergoing general anesthesia for non-ocular surgery. Corneal protection methods have been developed to reduce and eliminate the rate of this preventable complication. In this study, it was aimed to compare eye closure with hypoallergenic surgical tapes, eye closure with bio-occlusive dressing and antibiotic eye ointment for eye protection in patients undergoing septorhinoplasty under general anesthesia. Material method: The surgical files of all patients with ASA I and ASA II who underwent septorhinoplasty between 1 January 2019 and 31 December 2019 in our hospital were retrospectively analyzed. A total of 721 patients, 403 female, 318 male, were included in the study. The patients were divided into three groups according to the methods used for eye protection. The demographic features of the patients, the duration of the operation and the findings or complaints about the eyes, if any, before and after the operation were listed from the surgery and outpatient files. It was investigated whether the frequency of eye complaints and symptoms had a significant difference between patients with different eye protection methods. p <0.05 was considered statistically significant. Results: In 721 patients included in the study, it was determined that hypoallergenic surgical tape was applied to 198 patients, an eye ointment with antibiotics was applied to 302 patients, and a bio-occlusive dressing was applied to 221 patients. It was determined that two patients in Group I using hypoallergenic surgical tape and one patient in Group II using antibiotic eye ointment was observed to have a sting and rash that did not require treatment on the first day of the operation. These findings evaluated as CA were not statistically significant between the groups (p = 0.264). Conclusion: In septorhinoplasty surgery, there is no significant difference between closing the eyelids directly, applying ointment or closing with bio-occlusive material. However, the bio-occlusive dressing can be used in patients at risk of corneal pathology.

Keywords

Corneal abrasion, Eye care, Eye protection, General anesthesia, Perioperative eye injury, Bio-occlusive dressing

Genel anestezi altında yapılan septorinoplasti ameliyatlarında kornea abrazyonu oluşma riski

Abstract

Amaç: Tüm anestezik uygulamalarda, özellikle genel anestezi uygulanması sırasında gözün uygun bakımı gereklidir. Nonoküler cerrahi için genel anestezi uygulanan hastalarda en sık görülen oftalmolojik komplikasyon kornea hasarıdır. Bu önlenebilir komplikasyonun oranını azaltmak ve ortadan kaldırmak için kornea koruma yöntemleri geliştirilmiştir. Bu çalışmada genel anestezi altında septorinoplasti uygulanan hastalarda göz korunması amacıyla hipoallerjenik cerrahi flasterle göz kapatma, biyo-oklüzif şeffaf bantla göz kapatma ve antibiyotikli göz pomadı uygulanmasının karşılaştırılması amaçlanmıştır. Materyal metod: Hastanemizde 1 Ocak 2019 / 31 Aralık 2019 arasındaki Septorinoplasti yapılmış ASA I ve ASA II olan tüm hastaların ameliyat dosyaları retrospektif olarak incelendi. 403 kadın 318 erkek toplam 721 hasta çalışmaya dahil edildi. Hastalar, göz koruma için kullanılan yöntemlere göre 3 gruba ayrıldı. Ameliyat ve poliklinik dosyalarından hastaların demografik özellikleri, operasyon süreleri, operasyondan önce ve operasyondan sonraki dönemde varsa gözleri ile ilgili bulgu ya da şikâyetleri listelendi. Göz şikâyet ve bulgularının görülme sıklığının farklı göz koruma yöntemleri uygulanan hastalar arasında anlamlı bir farkları olup olmadığı araştırıldı. İstatiksel olarak p<0.05 anlamlı olarak kabul edildi. Bulgular: Çalışmaya dahil edilen 721 hastada göz koruma yöntemi olarak 198 hastaya nonallerjik flaster, 302 hastaya antibiyotikli göz pomadı, 221 hastaya biyo-oklüzif şeffaf bant uygulandığı tespit edildi. Nonallerjik flaster kullanılan Grup I’de 2 ve antibiyotikli göz pomadı kullanılan Grup II’de 1 hastada operasyonun 1. gününde tedavi gerektirmeyen batma ve kızarıklık görüldüğü tespit edildi. CA olarak değerlendirilmiş olan bu bulgular gruplar arasında istatiksel olarak anlamlı değildi (p=0,264). Sonuç: inoplasti cerrahisinde göz kapaklarını doğrudan bantlayarak kapatmak, merhem sürmek veya biyooklüzif malzeme ile kapatmak arasında anlamlı bir fark yoktur. Ancak kornea patolojisi riski olan hastalarda biyo-oklüzif şeffaf bantlar kullanılabilir.

Keywords

Bio-occlusive şeffaf bant, Genel anestezi, Göz bakımı, Göz koruması, Kornea hasarı, Perioperarif göz yaralanması

References

• Martin DP, Weingarten TN, Gunn PW, et al. Performance improvement system and postoperative corneal injuries: incidence and risk factors. Anesthesiology 2009; 111: 320-6.
• Morris A, Bonanno L, Bennett M. Effectiveness of corneal abrasion prevention interventions for adults undergoing general anesthesia for more than one hour: a systematic review protocol. JBI Database System Rev Implement Rep 2018; 16: 1785-90.
• Grixti A, Sadri M, Watts MT. Corneal protection during general anesthesia for nonocular surgery. Ocul Surf 2013; 11: 109-18.
• Taylor T, Major E. Hazards of reversal of neuromuscular blockade. Hazards and complications of anaesthesia 2nd ed Edinburgh: Churchill Livingstone. 1993: 234-5.
• Cuddihy PJ, Whittet H. Eye observation and corneal protection during endonasal surgery. J Laryngol Otol. 2005; 119: 556-7.
• Yu HD, Chou AH, Yang MW, Chang CJ. An analysis of perioperative eye injuries after nonocular surgery. Acta Anaesthesiol Taiwan. 2010; 48: 122-9.
• Anderson DA, Braun TW, Herlich A. Eye injury during general anesthesia for oral and maxillofacial surgery: etiology and prevention. J Oral Maxillofac Surg. 1995; 53: 321-4.
• Alharethy S, Aldrees T, Aljrid R, Alanazi A, Algaryan SK, Jang YJ. Common nasal deformities among rhinoplasty patients in a university hospital in Saudi Arabia. Ann Saudi Med. 2017; 37: 2017-211.
• Wilson SA, Last A. Management of corneal abrasions. Am Fam Physician. 2004; 70: 123-8.
• Papp AM, Justin GA, Vernau CT, et al. Perioperative Corneal Abrasions After Nonocular Surgery: A Systematic Review. Cornea. 2019; 38: 927-32.
• Moos DD, Lind DM. Detection and treatment of perioperative corneal abrasions. J Perianesth Nurs. 2006; 21: 332-41.
• Batra YK, Bali IM. Corneal abrasions during general anesthesia. Anesth Analg 1977; 56: 363-5.
• Segal KL, Fleischut PM, Kim C, et al. Evaluation and treatment of perioperative corneal abrasions. J Ophthalmol. 2014; 2014: 901901.
• Palte HD. Revisiting perioperative corneal abrasion. ASA Newsletter. 2018; 82: 22-5.
• White E, Crosse MM. The aetiology and prevention of peri-operative corneal abrasions. Anaesthesia. 1998; 53: 157-61.
• Gild WM, Posner KL, Caplan RA, Cheney FW. Eye injuries associated with anesthesia. A closed claims analysis. Anesthesiology. 1992; 76: 204-8.
• Grover VK, Kumar KV, Sharma S, Sethi N, Grewal SP. Comparison of methods of eye protection under general anaesthesia. Can J Anaesth. 1998; 45: 575-7.
• Kaye AD, Renschler JS, Cramer KD, et al. Postoperative Management of Corneal Abrasions and Clinical Implications: a Comprehensive Review. Curr Pain Headache Rep 2019; 23: 48.
• Snow JC, Kripke BJ, Norton ML, Chandra P, Woodcome HA. Corneal injuries during general anesthesia. Anesth Analg 1975; 54: 465-7.
• Reimer C. Eye taping during anesthesia and chlorhexidine exposure. Can J Anaesth 2017; 64: 1159-60.
• Wan T, Wang Y, Jin X-M. Corneal injury and its protection using hydro-gel patch during general anesthesia. Int J Ophthalmol 2014; 7: 964.
• Lee S-J, Im Kim S, Chung JK, et al. Comparison of eye protection methods for corneal abrasion during general anesthesia. Anesth Pain Med 2016; 11: 99-103.
• Prakash S. Perioperative eye protection under general anesthesia. J Anaesthesiol Clin Pharmacol 2013; 29: 138.
• Herbert L. Ophthalmology in anaesthesia and intensive care. Anaesth Intensive Care Med 2004; 5: 304-7.
• Demir N, Muluk NB, Velentin PT. Anesthesia for Rhinoplasty. All Around the Nose: Springer; 2020. p.783-7.
• Laverv H, Samadi D, Gainsburg D. 800 preventing ocular injuries during robotic prostatectomy: A simple technique. Eur Urol Suppl 2010; 9: 257.
• Ganidagli S, Cengiz M, Becerik C, Oguz H, Kilic A. Eye protection during general anaesthesia: comparison of four different methods. Eur J Anaesthesiol 2004; 21: 665-7.
• Shimmura S, Matsumoto K, Yaguchi H, et al. Acidic electrolysed water in the disinfection of the ocular surface. Exp. Eye Res 2000; 70: 1-6.