External patello-tibial transfixation. I: Indications and technique

We have studied the pattern of blood flow and pharmacodynamic profile of mivacurium-induced block at the adductor pollicis and orbicularis oculi muscles. We studied 30 adult patients anaesthetized with fentanyl, thiopentone, nitrous oxide-isoflurane, and mivacurium 0.2 mg kg-1. Neuromuscular transmission was monitored with accelerometry (TOF Guard, Biometer, Denmark). Blood flow was measured at the two muscles with the use of a laser Doppler flowmeter (Laserflo BPM2, Vasamedics, USA). All patients developed 100% neuromuscular block at the adductor pollicis muscle. Mean maximum neuromuscular block at the orbicularis oculi was 96.4 (SD 3.5)% (ns). Onset time, time required for 25% and 75% recovery of the first twitch in the train-of-four (T1), and a train-of-four ratio (T4/T1) of 90% at the orbicularis oculi were respectively, mean 130.4 (SD 28.5) s, 9.1 (3.2) min, 16.2 (3.9) min and 20.2 (4.3) min and were significantly shorter than the corresponding values at the adductor pollicis: 202.7 (37.2) s, 12.9 (3.9) min, 21.1 (5.1) min and 30.8 (7.4) min. For a given T1, there was significantly less train-of-four fade (T4/T1) at the orbicularis oculi than at the adductor pollicis muscle during recovery. Blood flow was comparable at the two muscles before induction of anaesthesia. Thiopentone significantly increased thenar muscle blood flow from 2.9 (1.5) to 12.3 (6.8) ml 100 g-1 min-1, with a further increase to 22.7 (8.0) ml 100 g-1 min-1 after isoflurane (P < 0.001). Blood flow at the orbicularis oculi was not altered by thiopentone or isoflurane and was consistently lower than that at the adductor pollicis muscle. We conclude that the different pharmacodynamic profiles of mivacurium-induced block at the orbicularis oculi and adductor pollicis muscles were not related primarily to a difference in blood flows.     

Sub-Tenon's anaesthesia: an efficient and safe technique

AIM: To evaluate sub-Tenon's anaesthesia as an alternative to peribulbar anaesthesia. METHODS: 109 consecutive patients listed for various eye operations (including cataract, trabeculectomy, and vitrectomy) under peribulbar anaesthesia were operated on under sub-Tenon's anaesthesia instead. After topical anaesthesia a buttonhole was fashioned through the conjunctiva and Tenon's capsule 10 mm posterior to the limbus. 1.5 ml of lignocaine 2% was then delivered to the posterior sub-Tenon's space using a blunt cannula. The surgical procedure was performed immediately after the completion of the anaesthetic procedure. Chemosis, conjunctival haemorrhage, degree of akinesia, and pain scoring were analysed. RESULTS: There were no anaesthesia related complications. The administration of the block was painless for 99.1% of the patients. In all, 97.3% reported no pain during surgery. There was no akinesia when assessed just after the completion of the block and akinesia was limited when assessed after surgery. Chemosis and conjunctival haemorrhage were frequent but caused no intraoperative problems. CONCLUSION: Sub-Tenon's anaesthesia is an efficient and safe anaesthetic technique. It is a good alternative to peribulbar anaesthesia.     

Redraping the inferior orbicularis arc

The surgical technique of redraping of the inferior arc of the orbicularis oculi muscle is used primarily to produce lower lid and midfacial smoothing in patients undergoing aesthetic surgery. The midfacial fat compartments, suborbicularis oculi fat and malar fat, are bound to the orbicularis muscle by the superficial muscular aponeurotic system so that redraping the orbicularis muscle also repositions the midface. Orbicularis arc redraping should be accompanied by lateral canthoplasty to ensure stability to the shape of the eyelid fissure postoperatively. Modifications in orbicularis redraping and canthoplasty technique are necessary in patients with prominent eyes and distensible lower lids. Supraplacement of canthal fixation is needed in patients with prominent eyes, and lid shortening is needed in patients who have distensible lower lids. This technique also can be used in patients undergoing reconstructive surgery for correction of lower lid retraction because of its ability to recruit periorbital skin upward into the lower lid. For more severe cases of lower lid retraction after aesthetic surgery, adjunctive procedures such as spacer implants in the lower lid and periosteal flap canthoplasty can be used together with the orbicularis arc redraping to rehabilitate patients.     

Gold weights for the treatment of lagophthalmos caused by facial paralysis. Our experience and review of the literature

Paralysis of the orbicularis oculi muscle in patients with facial palsy can originate serious functional and esthetic problems. The implantation of a gold weight in the upper eyelid is one of the many surgical techniques that have been described for the correction of lagophthalmos in these patients. In this article we review the literature and present our experience with gold weight implantation for eyelid reanimation in patients with facial palsy. This procedure is technically simple to perform, produces good functional and cosmetic results, has a relatively low complication rate and is reversible should facial function return.     

Lewy body diseases and multiple system atrophy as alpha-synucleinopathies

BACKGROUND AND OBJECTIVES: The authors hoped to reduce the need for preoperative sedation and intravenous pain medication during cataract surgery by converting from peribulbar anesthesia to sub-Tenon's anesthesia. PATIENTS AND METHODS: A consecutive series of 2453 cataract patients' charts were reviewed. Each patient had previously watched a videotape explaining the anesthetic method to be used. Requests for preoperative sedation were compared between patients who received peribulbar or sub-Tenon's anesthesia. A sample of 200 charts of nonsedated patients were reviewed to compare intraoperative pain and motility. RESULTS: Intraoperative freedom from pain was reported by 91% of the peribulbar patients and 99% of the sub-Tenon's patients. Preoperative sedation was reduced from 26% of the peribulbar patients to 6.7% of the sub-Tenon's patients. CONCLUSIONS: Sub-Tenon's anesthesia provided excellent intraoperative pain relief and reduced the need for preoperative sedation, making it a satisfactory anesthetic technique for patients undergoing cataract phacoemulsification in an ambulatory surgery facility.     

Treatment of incomplete analgesia after placement of an epidural catheter and administration of local anesthetic for women in labor

BACKGROUND: Approximately 15% of women still have pain after placement of an epidural catheter and administration of local anesthetic for labor analgesia. Two techniques frequently used to treat this pain were compared: (1) withdrawal of the catheter 1 cm and repeated dosing with additional local anesthetic, and (2) repeated dosing with additional local anesthetic without any catheter manipulation. METHODS: Fifteen minutes after placement of a multiple-orifice epidural catheter 5 cm into the epidural space and administration of 13 ml 0.25% bupivacaine to the parturient in labor, the adequacy of analgesia was assessed. All women who had incomplete analgesia were randomized (first intervention) to receive an additional 5 ml 0.25% bupivacaine (local-anestheticonly group) or to receive 5 ml 0.25% bupivacaine after first withdrawing the epidural catheter 1 cm (catheter-manipulation group). If after 15 min the woman still had pain, then (second intervention) the catheter was withdrawn 1 cm and an additional 5 ml 0.25% bupivacaine was administered to the local-anesthetic-only group, whereas 5 ml 0.25% bupivacaine was given to the catheter-manipulation group without further catheter manipulation. The success rate of the second intervention was assessed 15 min later. RESULTS: Seventy-eight women were enrolled in the study, 39 to each group. In the local-anesthetic-only group, 29 (74%) women were successfully treated with the first intervention and the remaining 10 (100%) were successfully treated with the second intervention. In the catheter-manipulation group, 30 (77%) were successfully treated with the first intervention and 7 (100%; 2 patients were not studied because of investigator error) were successfully treated with the second intervention (P=NS). CONCLUSIONS: Administration of additional local anesthetic without first withdrawing the epidural catheter will effectively treat most women for whom analgesia is incomplete after the placement of an epidural catheter during labor.     

Basal cell adenocarcinoma of the salivary glands: comparison with basal cell adenoma through assessment of cell proliferation, apoptosis, and expression of p53 and bcl-2

Local anesthetics, particularly bupivacaine, are known to be myotoxic to skeletal muscle. Injury is followed by satellite cell mediated regeneration. The eyelid is a common site for the injection of local anesthetics. Due to the complex anatomy of this region and the unique properties of facial musculature compared to limb skeletal muscle, the response of the orbicularis oculi to local injection of bupivacaine was examined to determine the time course of maximum satellite cell activation and division. The lower eyelids of rabbits were injected with two doses of a combination of bupivacaine and hyaluronidase, spaced 18 h apart. To assess the time course of satellite cell division, bromodeoxyuridine (BrdU) was injected immediately or, 1, 2, 3, 6 or 13 days after the second bupivacaine injury. The rabbits were sacrificed 24 h later. The eyelids were prepared for immunohistological examination and morphometric analysis of the presence of CD11-positive monocytes, neutrophils and macrophages, MyoD expression in satellite cells and/or myoblasts, and co-expression of BrdU and the developmental myosin heavy chain isoform. One day after bupivacaine injury of the orbicularis oculi, there was a large influx of CD11-positive cells which gradually decreased over time. Maximum activation of satellite cells, as defined by MyoD expression, occurred 2 and 3 days after the injury. Using double labeling techniques, the peak of BrdU incorporation occurred on day 3 and was identified in developmental myosin co-labeled cells 4 days after injury. The peak of satellite cell activation and division occurred 3 days after bupivacaine induced injury, as demonstrated by both MyoD expression and after pulse labeling with BrdU as identified in double labeled cells positive for BrdU and the developmental myosin heavy chain isoform. The process of regeneration in this muscle extended beyond the duration of this study. Muscle fibers remained small in cross-sectional area and positive for developmental myosin 2 weeks after injury, at a time when the fiber number had reached control, uninjured levels.     

Delay of clinical recovery from paralysis induced by atracurium: comparison between orbicularis oculi and adductor pollicis

OBJECTIVE: To compare with train-of-four stimulation the delays of the beginning of the spontaneous recovery of the orbicularis oculi and of the adductor pollicis after profound neuromuscular blockade with atracurium. STUDY DESIGN: Prospective, comparative open study. PATIENTS AND METHODS: Twenty-eight physical class ASA 1 and 2 patients under general anaesthesia (propofol, N2O, fentanyl) and profound neuromuscular blockade with atracurium. Train-of-four stimulation, every 10 s, of the ulnar nerve at the wrist (for assessing by tactile means the response of the adductor pollicis) and of the temporal branch of the facial nerve (for assessing visually the response of the orbicularis oculi). On each site, measurement of the delay between the end of the maintenance of deep neuromuscular blockade (last dose of atracurium) and the beginning of the recovery (first response to train-of-four stimulation). RESULTS: In each case, the recovery of the orbicularis oculi began earlier than the recovery of the adductor pollicis (26 +/- 9 min vs 34 +/- 9 min, P < 0.001). The delays of recovery at each site were strongly correlated (r = 0.87; P < 0.001) but the time lag between the responses varied greatly: 1 to 21 min, mean: 8 +/- 5 min, coefficient of variation: 56.6%. CONCLUSION: The orbicularis oculi should not be monitored alone for assessment of recovery from profound neuromuscular blockade by atracurium, as it predicts poorly the time of the recovery of the adductor pollicis.     

Histological studies in the developing eyelids of congenital microphthalmic (Cts) mice

The Cts mouse is a mutant of the Jcl:ICR strain with congenital cataract and small eyes in homozygotes. In the present study, attempts were made to measure postnatally the palpebral fissure and to examine the process of eyelid development by light microscopy in both normal (+/+) and homozygous (Cts/Cts) mice. The width of the palpebral fissure in homozygotes was significantly smaller than in unaffected mice. To investigate the process of eyelid development, tissue specimens from normal and Cts homozygous mice were prepared with hematoxylin and eosin, and observed by light microscopy on days 14, 16, and 18 of gestation and on days 0, 7, and 14 after birth. In both groups, the eyelid fused on day 16 of gestation and opened completely on day 14 after birth. The primordium of the orbicularis oculi muscle was defined on day 16 of gestation, and the primordia of hair follicles and Meibomian glands were detected on day 18 of gestation. In the present study, there were no significant differences in the process of eyelid development between normal and homozygous mice. Eyelid development has thus far been thought to be self-determining and not affected by tissue interaction, and the present findings support this line of thought.     

Subconjunctival versus peribulbar anesthesia in trabeculectomy: a prospective, randomized study

BACKGROUND AND OBJECTIVE: To compare the use of subconjunctival and peribulbar anesthesia for trabeculectomy. PATIENTS AND METHODS: Sixty patients undergoing trabeculectomy were prospectively randomized to receive either peribulbar or subconjunctival anesthesia. Peribulbar anesthesia consisted of a 3-ml inferior and a 1-ml superior injection of a 1:1 mixture of 2% mepivacaine, 0.75% bupivacaine, and hyaluronidase. Subconjunctival anesthesia consisted of a 1- to 2-ml injection of the same mixture without hyaluronidase in the superotemporal quadrant. Intraoperative pain, presence of eye movements, and complications during surgery were evaluated. RESULTS: The frequency and intensity of pain was statistically similar between the two groups. All episodes of pain (20% in the subconjunctival group and 6.6% in the peribulbar group) were rated as mild. Eye movement was more common in the subconjunctival group than in the peribulbar group, but it was controlled by verbal command and did not interfere with the procedure. No clinically significant complications occurred during surgery. CONCLUSION: Subconjunctival anesthesia is an effective alternative to peribulbar anesthesia for trabeculectomy.     

Extracellular amino acid levels in the interpositus nucleus during classical eyeblink conditioning in alert cats.

The extracellular levels of selected amino acids in the cerebellar posterior interpositus nucleus (PIN) during classical eyeblink conditioning was analyzed in alert cats using a delay paradigm. Animals were prepared for the chronic recording of eyelid movements (with the magnetic search-coil technique) and the electromyographic activity of the orbicularis oculi muscle. With the help of a guide and push-pull cannulae, selected PIN sites were perfused daily during classical eyeblink conditioning. The perfusate was sampled at intervals of 5 min and analyzed with a high-pressure liquid chromatography- electrochemical detection (HPLC-EC) method. The analysis of push-pull perfusate revealed a significant increase in the release of glycine, taurine, and glutamate across the successive conditioning sessions, in parallel with the acquisition of eyelid conditioned responses (CRs). Both CRs and extracellular levels of these three amino acids returned to control values during extinction. Other amino acids (alanine, GABA, glutamine, serine, and threonine) did not undergo modifications in their extracellular concentrations across the training. Results are discussed with regard to the role of PIN in this type of associative learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peribulbar and retrobulbar anesthesia with prilocaine: a comparison of two methods of local ocular anesthesia

Prilocaine (Citanest) has been shown to be a satisfactory alternative to lignocaine, with certain important advantages, including superior diffusion. The latter may be especially important in peribulbar anesthesia, where the level of diffusion is a critical factor in providing a timely, high-quality block. In a prospective randomized study, we compared the effectiveness of peribulbar vs retrobulbar administration of prilocaine. Eighty-seven patients undergoing elective intraocular surgery were randomized to receive either retrobulbar or peribulbar anesthesia with prilocaine 3% with felypressin and hyaluronidase. Pain of injection, akinesia, and anesthesia were evaluated at predetermined intervals after injection. Except for the fact that lid akinesia occurred earlier in the peribulbar group, there was no difference in the quality or rate of onset of overall akinesia in the two groups. Nor were there any differences in the pain associated with injection. Both groups had excellent operative anesthesia and akinesia.     

Trigeminal inputs to eyeblink motoneurons in the rabbit

The rabbit nictitating membrane and eyeblink response is widely used in studies of classical conditioning. Eyeblinks involve coordinated activation of the orbicularis oculi motoneurons (OOcVII) and accessory abducens motoneurons (AccVI) which close the external eyelids and nictitating membrane, respectively, and inhibition of levator palpebrae motoneurons (LPIII) whose activity raises the upper eyelid. The identification of blink interneurons that may coordinate these responses is an important step in the analysis of mechanisms supporting eyeblink conditioning as they are likely to receive convergent inputs from circuitry associated with learned as well as unlearned responses. We first investigated the distribution of OOcVII motoneurons in the facial nucleus and LPIII motoneurons in the oculomotor nucleus by retrograde tracing of wheat germ-agglutinated horseradish peroxidase (WGA-HRP) injected into the appropriate muscles. We then used an anterograde tracing method to locate trigeminal and paratrigeminal inputs to OOcVII, to AccVI nucleus, and to LPIII. Injections of WGA-HRP were placed into the principal trigeminal nucleus (Vp) and into all divisions of the spinal trigeminal nucleus. We found an area in Vp and the adjacent rostral parts of pars oralis of the spinal trigeminal nucleus that gave clear projections to OOcVII and AccVI motoneurons and adjacent to LPIII motoneurons in the contralateral oculomotor nucleus. We suggest that neurons in this premotor blink area in rabbits can coordinate learned and reflex blink responses involving the external eyelids and the nictitating membrane. In addition, there are direct projections from the pars interpolaris and pars caudalis of the spinal trigeminal nucleus to the facial nucleus that may mediate short latency responses of the external eyelid orbicularis oculi muscle alone.     

Effect of subarachnoid bupivacaine block on anesthetic requirements for thiopental in rats

BACKGROUND: Subarachnoid bupivacaine blockade has been reported to reduce thiopental and midazolam hypnotic requirements in patients. The purpose of this study was to examine if local anesthetically induced lumbar intrathecal blockade would reduce thiopental requirements for blockade of motor responses to noxious and nonnoxious stimuli in rats. METHODS: After intrathecal and external jugular catheter placement, rats were assigned randomly to two groups in a crossover design study, with each rat to receive either 10 microl of 0.75% bupivacaine or 10 microl of normal saline intrathecally. The doses of intravenously administered thiopental required to ablate the eyelid reflex, to block the withdrawal reflex of a front limb digit, and to block the corneal reflex were compared. In two separate groups of animals, hemodynamic parameters and concentrations of thiopental in the brain were compared between intrathecally administered bupivacaine and saline. RESULTS: The thiopental dose required to block the described responses was decreased with intrathecally administered bupivacaine versus intrathecally administered saline from (mean +/- SD) 40 +/- 5 to 24 +/- 4 mg/kg (P < 0.001) for the eyelid reflex, from 51 +/- 6 to 29 +/- 6 mg/kg (P < 0.005) for front limb withdrawal, and from 67 +/- 8 to 46 +/- 8 mg/kg (P < 0.01) for the corneal reflex. The concentration of thiopental in the brain at the time of corneal reflex blockade for the group given bupivacaine was significantly lower than in the group given saline (24.1 vs. 35.8 microg/g, P = 0.02). CONCLUSION: This study demonstrates that lumbar intrathecally administered local anesthetic blockade decreases anesthetic requirements for thiopental for a spectrum of end points tested. This effect is due neither to altered pharmacokinetics nor to a direct action of the local anesthetic on the brain; rather, it is most likely due to decreased afferent input.     

Effect of DMSO and exchange volume on outflow resistance washout and response to pilocarpine during anterior chamber perfusion in monkeys

PURPOSE: To determine the dependence of outflow resistance washout on anterior chamber (AC) fluid exchange volume (EV); the minimum EV required for complete AC mixing, and the effect of 0.01-5% DMSO in the exchange solution on outflow resistance. METHODS: Total outflow facility was determined in 63 pentobarbital-anesthetized cynomolgus monkeys, before and after AC exchange, for 10 min, with 1, 2, and 4 ml of Bárány's perfusand, containing 0.01-5% DMSO or containing 1 microgram/ml or 5 micrograms/ml pilocarpine HCL (pilo), each volume. RESULTS: Post-exchange facility increased by 21% (p < 0.05) vs. baseline for both the 1 and 2 ml Bárány's volumes and by 50% (p < 0.001) for the 4-ml volume. Washout-corrected post-exchange facility was unchanged from baseline, following 1 or 2 ml exchange with 1 microgram/ml pilo; 5 micrograms/ml pilo increased facility by 130 +/- 41% and 174 +/- 40% respectively, relative to baseline. Exchange with 4 ml of 1 microgram/ml pilo increased facility 72% more than the 2 ml (p < 0.029) and 100% more than the 1 ml (p < 0.014) volumes. When corrected for their respective baselines, 2 ml of 5 micrograms/ml pilo increased facility 12.7 +/- 4.4% more than the 1 ml volume (p < 0.05). Post exchange facility was not significantly increased over baseline in eyes exchanged with 2 ml of 0.01-4% DMSO or in eyes exchanged with Bárány's alone. When corrected for their respective baselines, post-exchange facility was significantly lower in eyes exchanged with 5% DMSO vs. Bárány's (p = 0.022). CONCLUSIONS: One- and 2-ml EVs preserve outflow resistance equally well, and substantially better than 4 ml. Two ml is the minimum volume necessary for adequate mixing of AC drug solutions, to achieve the full facility effect. Concentrations of DMSO up to 4% in a 2-ml EV can solubilize compounds without additionally decreasing outflow resistance.     

Electrical study of jaw and orbicularis oculi reflexes after trigeminal nerve surgery

Trigeminal nerve ophthalmic and motor division function was assessed clinically and electrically in 32 patients who had undergone various surgical procedures for trigeminal neuralgia. Using known electrophysiological techniques, the orbicularis oculi and jaw reflexes were tested in all subjects. Abnormalities of the orbicularis oculi reflex were anticipated on the basis of ophthalmic division anaesthesia. However, jaw reflex abnormalities appeared in operated cases with no clinical or electromyographic evidence of masseter denervation. These results were unexpected, and imply that the proprioceptive fibres of the jaw reflex are mediated by a sensory and not a motor root as previously believed.     

The psychophysiology of James Bond: Phasic emotional responses to violent video game events.

The authors examined emotional valence- and arousal-related phasic psychophysiological responses to different violent events in the first-person shooter video game "James Bond 007: NightFire" among 36 young adults. Event-related changes in zygomaticus major, corrugator supercilii, and orbicularis oculi electromyographic (EMG) activity and skin conductance level (SCL) were recorded, and the participants rated their emotions and the trait psychoticism based on the Psychoticism dimension of the Eysenck Personality Questionnaire--Revised, Short Form. Wounding and killing the opponent elicited an increase in SCL and a decrease in zygomatic and orbicularis oculi EMG activity. The decrease in zygomatic and orbicularis oculi activity was less pronounced among high Psychoticism scorers compared with low Psychoticism scorers. The wounding and death of the player's own character (James Bond) elicited an increase in SCL and zygomatic and orbicularis oculi EMG activity and a decrease in corrugator activity. Instead of joy resulting from victory and success, wounding and killing the opponent may elicit high-arousal negative affect (anxiety), with high Psychoticism scorers experiencing less anxiety than low Psychoticism scorers. Although counterintuitive, the wounding and death of the player's own character may increase some aspect of positive emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amygdala stimulation enhances the rat eyeblink reflex through a short-latency mechanism.

Amygdala stimulation was shown to enhance the trisynaptic (fast, R1) component of the electromyogram recorded in the rat orbicularis oculi (oo) muscle, which is responsible for the active force generating eyelid closure. The eyeblink was elicited via direct electrical stimulation of the supraorbital branch of the trigeminal nerve. Possible mechanisms responsible for the effect of amygdala stimulation on the eyeblink reflex were evaluated by measuring the amount of R1 enhancement as a function of the interstimulus interval (ISI) between the onset of amygdala and trigeminal nerve stimulation. Amygdala stimulation produced significant R1 enhancement at ISIs that imply short-latency excitation of the eyeblink circuit by way of a fast-acting neurotransmitter. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuous extradural infusion of ropivacaine 2 mg ml-1 for pain relief during labour

We have assessed the dose-response relationship of a solution of ropivacaine 2 mg ml-1, given as a continuous extradural infusion to women in labour. A total of 133 parturients were allocated randomly to one of four groups to receive a fixed rate ropivacaine infusion of 4, 6, 8 or 10 ml h-1 with additional bolus doses as necessary. Contraction pain, quality of analgesia, sensory block, motor block and neonatal Apgar scores were assessed. There were no significant differences between groups in terms of analgesia or motor block, although significantly more bolus doses were required by the group receiving 4 ml h-1 (P < 0.05 compared with the other groups), and a significantly higher total dose of ropivacaine was administered to the 10-ml h-1 group compared with the 6-ml h-1 group (P = 0.044). There were no significant differences between groups in terms of obstetric or neonatal outcome. We conclude that ropivacaine 2 mg ml-1 was effective and well tolerated when given as a continuous extradural infusion at 6-8 ml h-1 and may be used as the sole analgesic during labour.     

Monitoring orbicularis oculi predicts good intubating conditions after vecuronium in children

PURPOSE: The aim of the study was to compare visual estimation of onset of neuromuscular blockade at both the adductor pollicis (AP) and the orbicularis oculi (OO) in children and to determine if monitoring the OO could predict good intubating conditions during vecuronium-induced neuromuscular blockade. METHODS: Thirty ASAI--II children (1.5-9 yr) were studied. Anaesthesia was induced with 6-8 mg.kg-1 thiopentone. The ulnar nerve at the wrist and the temporal branch of the facial nerve were stimulated every 10 sec using train-of-four (TOF) stimuli. Vecuronium, 0.15 mg.kg-1, was administered as a bolus. The responses at both the OO and the AP were evaluated visually. Patients were randomly divided into two groups. In the AP group (n = 15), the trachea was intubated when the AP was completely blocked. In the OO group (n = 15), intubation was performed when the OO was completely blocked. Intubating conditions were scored on a scale of 1 to 4. RESULTS: All the patients had complete blockade at both the orbicularis oculi and the adductor pollicis. In the two group, time from injection of vecuronium to complete neuromuscular blockade was shorter at the orbicularis oculi than at the adductor pollicis, 1.5 +/- 0.5 min vs 2.3 +/- 0.7 min, respectively, (P < 0.05; mean +/- SD) in the AP group, 1.7 +/- 0.3 min vs 2.3 +/- 0.8 min, respectively in the OO group (P < 0.05). Intubating conditions were excellent in all patient except one, where it was rated as good. They did not differ between groups. CONCLUSION: Following administration of 0.15 mg.kg-1 vecuronium in children, monitoring of the OO can detect good intubating conditions 0.7 min earlier than with monitoring of the AP.