Canadian Journal of Anesthesia/Journal canadien d'anesthésie volume 65, pages 1273–1274 (2018)Cite this write-up
Anesthesia carriers commonly use adhesive tape over the eyelids of patients throughout general anesthesia. While this practice may decrease the hazard of corneal abrasion and also keratitis from inadvertent exposure to chlorhexidine,1,2 patients may experience differing degrees of cutaneous irritation from the adhesive. We report the instance of a patient that had a full-thickness epidermal skin loss through purpura over the left eyelid after removal of 3M Durapore™ adhesive tape (3M, St. Paul, MN, USA) at the finish of basic anesthesia. She offered consent to publication of this report.
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The patient was a 44-yr-old non-cigarette smoking female through a history of renal mass booked for radical robot-assisted laparoscopic nephrectomy. She had actually previously undergone appendectomy, fibroidectomy, and repair of umbilical hernia, all without any anesthetic complications. The patient was otherwise healthy and balanced and not taking any medicines.
After induction of basic anesthesia and uneventful intubation, 3M Durapore adhesive tape was put over each of patient’s eyelids. At the end of the three-hour surgical treatment, the tape was removed and also a full-thickness epidermal skin loss via purpura was listed on the medial left upper eyelid roughly 25 mm × 5 mm in dimension (see Figure). The skin flap was uncovered on the adhesive side of the removed tape. Ptosis of the best eyelid was provided in the recovery room. The patient was began on topical antibiotic and steroid ointment to prevent svehicle development per ophthalmologic referrals. She was likewise started on apraclonidine ophthalmic drops for the appropriate eye ptosis. Six months after the anesthetic, a svehicle continues to be over the left eyelid (view Figure). This case highlights that while tape via maximal adhesive properties may host the eye closed throughout surgery, such adhesion in between the skin and the tape might be stronger than the adhesive pressures of skin cells, resulting in skin separation and also injury as soon as the tape is rerelocated.
Panel A reflects full-thickness epidermal skin loss via purpura on the medial left top eyelid on postoperative day 1. Panel B reflects sauto formation on the left eyelid six months later
While eye injuries throughout non-ophthalmologic surgical procedure are rare, they are a vital determinant of anesthesia licapacity. In 1992, Gild et al. reported that 71 out of 2,046 claims studied as part of the American Society of Anesthesiologists Closed Clintends Project were versus anesthesiologists for eye injuries.3 Corneal abrasions were the most prevalent, making up 25 of the 71 eye injury claims. Given these findings, the use of adhesive tape to keep the eyes shut during surgical treatment is essential to decrease the risk of such eye injuries.
Eyelid injury has actually also been reported in retrospective studies of anesthesia-associated injuries.4 While the suspected etiology of eyelid injury is the adhesive,2 there has been incredibly little scientific examination right into the risk of cutaneous injury with the usage of various adhesive tapes. In the only double-blind, randomized trial, which compares 2 different kinds of adhesive tape for securing eyes in the time of anesthesia, patients were randomized to traditional acrylate tape (3M Medipore™ tape) vs 3M™ Kind Removal™ silicone tape. Patients were more most likely (37% vs 3%) to have skin denudation with standard acrylate tape vs silicone tape as evaluated by the anesthesiologist.2 Furthermore, patient satisfaction through the problem of the skin over the eyelids on postoperative day 1 was considerably greater with silicone tape.2
In an age wright here patient satisfaction is being provided as a top quality metric,5 minimizing the danger of eyelid injury is a crucial determinant of top quality. At this time, the scientific body of literary works concerning this topic is as well little, so we would advocate for randomized regulated trials to much better understand also which adhesive tape offers the smallest risk and also the highest possible top quality of treatment to our patients. The appropriate adhesive tape would have actually minimal corneal abrasion and also minimal skin eyelid injury.
The authors discshed that there was no capital resource for this work, there are no commercial or non-commercial affiliations that may be perceived to be a problem of interemainder through the work-related, and tbelow are no other associations in relation to this work-related.
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This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, Canadian Journal of Anesthesia.
Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA, USA
Dan M. Drzymalski MD, Harold Arkoff MD & Ruben J. Azocar MD
Cite this article
Drzymalski, D.M., Arkoff, H. & Azoautomobile, R.J. Eyelid injury after usage of 3M Durapore™ tape throughout basic anesthesia. Can J Anesth/J Can Anesth 65, 1273–1274 (2018). https://doi.org/10.1007/s12630-018-1202-3