AUTHOR=Chaurasia Shweta , Soni Shiv Lal , Ganesh Venkata , Ram Jagat , Sukhija Jaspreet , Chaurasia Swati , Takkar Aastha 

TITLE=Tonic down-rolling and eccentric down-positioning of eyes under sevoflurane anesthesia without non-depolarizing muscle relaxant and its relationship with depth of anesthesia

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1029952

DOI=10.3389/fmed.2023.1029952

ISSN=2296-858X

ABSTRACT=Purpose: To analyze the relationship between eccentric downward eye movement/eccentric downward eye-positioning (EDEM/EDEP) encountered in patients undergoing ophthalmic surgeries and its return to centralized position under general anesthesia (GA) with the depth of anesthesia (DOA) 
Methods: Patients undergoing ophthalmic surgeries (6months-12years) under sevofluorane anesthesia without non-depolarizing muscle relaxant (NDMR) who witnessed a sudden tonic EDEM/EDEP were both retrospectively (R-group) and prospectively (P-group) enrolled (ambispective study). R-group included data-points after induction (AI) till the time surgery lasted while P-group compiled data both during induction (DI) and AI. DOA in terms of MAC (minimum alveolar concentration) at the time of EDEM/EDEP and centralization of eyeball and their timings were noted and compared for both AI and DI data-points. Also, Vertical eccentric eye positions were scored and correlated with MAC.
Results: AI data included 22 (14R+8P) events and their mean MAC of EDEM/EDEP and centralization were 1.600.25 and 1.180.17 respectively (p=0.000). DI data included 62 (P) cases and its mean MAC of EDEM/EDEP and centralization was 2.190.43 and 1.390.26 respectively (p=0.000). Median (IQR) eye positions during down-positioning in 84 events was -3(-3.9 to -2.5). It was preceded by an eccentric upward drift of eyes in 10/22 (6R+4P) AI cases. A strong negative correlation was seen between DOA and eccentric eye positions (r=-0.77, p=0.000). 
Conclusions: Tonic down-rolling of eyes is not an uncommon entity in children seen without NDMR with higher depths of sevofluorane anesthesia compared to point of centralization and fluctuations in DOA should be avoided to circumvent inadvertent complications during ocular surgery.