Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is ...associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.
Forty patients aged 5–16 years with American Society of Anesthesiologists status I–II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.
There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05).
In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.
A cirurgia de estrabismo é um procedimento oftalmológico comum em pediatria. Um grande problema que ocorre com frequência em pacientes submetidos a esse tratamento envolve o reflexo oculocardíaco. Esse reflexo está associado ao aumento da incidência de náusea, vômito e dor. O objetivo deste estudo foi investigar os efeitos do bloqueio subtenoniano sobre o reflexo oculocardíaco, a dor, a náusea e o vômito no período pós-operatório.
Foram incluídos no estudo 40 pacientes entre 5-16 anos, estado físico ASA I-II, submetidos à cirurgia eletiva de estrabismo. Foram randomicamente alocados em dois grupos, com o método de envelope lacrado. No Grupo 1 (n=20),pacientes não receberam bloqueio subtenoniano. No Grupo 2 (n=20), após a intubação, o bloqueio subtenoniano foi feito no olho submetido à cirurgia. Uso de atropina, escores de dor, reflexo oculocardíaco e incidência de náusea e vômito foram comparados.
Não houve diferença significativa entre os grupos em relação ao reflexo oculocardíaco e ao uso de atropina (p>0,05). Os escores de dor em 30minutos de pós-operatório foram significativamente menores no Grupo 2 do que no Grupo 1 (p<0,05). A necessidade de analgésico adicional durante o período pós-operatório foi significativamente menor no Grupo 2 do que no Grupo 1 (p<0,05).
O bloqueio subtenoniano, em combinação com anestesia geral, não é eficaz e confiável para diminuir o reflexo oculocardíaco, bem como náusea e vômito pós-operatórios (NVPO). Porém, esse método é seguro para diminuir a dor no período pós-operatório e reduzir a analgesia adicional necessária em cirurgia de estrabismo pediátrico.
Strabismus surgery is a frequently performed pediatric ocular procedure. A frequently occurring major problem in patients receiving this treatment involves the oculocardiac reflex. This reflex is ...associated with an increased incidence of postoperative nausea, vomiting, and pain. The aim of this study was to investigate the effects of a sub-Tenon's block on the oculocardiac reflex, pain, and postoperative nausea and vomiting.
40 patients aged 5-16 years with American Society of Anesthesiologists status I-II undergoing elective strabismus surgery were included in this study. Patients included were randomly assigned into two groups by using a sealed envelope method. In group 1 (n=20), patients did not receive sub-Tenon's anesthesia. In group 2 (n=20), following intubation, sub-Tenon's anesthesia was performed with the eye undergoing surgery. Atropine use, pain scores, oculocardiac reflex, and postoperative nausea and vomiting incidences were compared between groups.
There were no significant differences between groups with regard to oculocardiac reflex and atropine use (p>0.05). Pain scores 30min post-surgery were significantly lower in group 2 than in group 1 (p<0.05). Additional analgesic needed during the postoperative period was significantly lower in group 2 compared to group 1 (p<0.05).
In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.
Ventricular fibrillation occurring in a patient can result in unexpected complications. Here, our aim is to present a case of ventricular fibrillation occurring immediately after anesthesia induction ...with etomidate administration.
A fifty-six-year-old female patient with a pre-diagnosis of gallstones was admitted to the operating room for laparoscopic cholecystectomy. The induction was performed by etomidate with a bolus dose of 0.3mg/kg. Severe and fast adduction appeared in the patient's arms immediately after induction. A tachycardia with wide QRS and ventricular rate 188beat/min was detected on the monitor. The rhythm turned to VF during the preparation of cardioversion. Immediately we performed defibrillation to the patient. Sinus rhythm was obtained. It was decided to postpone the operation due to the patient's unstable condition.
In addition to other known side effects of etomidate, very rarely, ventricular tachycardia and fibrillation can be also seen. To the best of our knowledge, this is the first case regarding etomidate causing VF in the literature.
A ocorrência de fibrilação ventricular em um paciente pode resultar em complicações inesperadas. Nosso objetivo é apresentar um caso de fibrilação ventricular que ocorreu após a indução anestésica com administração de etomidato.
Paciente do sexo feminino, 56 anos, com pré-diagnóstico de cálculos biliares, foi admitida na sala de cirurgia para colecistectomia laparoscópica. A anestesia foi induzida com a administração de etomidato com uma dose em bolus de 0,3mg/kg. A paciente apresentou uma grave e rápida adução dos braços logo após a indução. Taquicardia com QRS largo e frequência ventricular de 188bpm foram detectadas no monitor. O ritmo converteu-se em fibrilação ventricular (FV) durante a preparação para a cardioversão. A paciente foi imediatamente submetida a desfibrilação. O ritmo sinusal foi obtido. Decidimos adiar a cirurgia por causa da condição de instabilidade da paciente.
Além dos efeitos secundários conhecidos de etomidato, taquicardia ventricular e fibrilação, embora muito raramente, também podem ser observadas. Até onde sabemos, esse é o primeiro caso na literatura de FV causado por etomidato.
The induction and inhibition of cytochrome P450 isoenzymes by antiepileptic drugs lead to changes in the clearance of anesthetic drugs eliminated via hepatic metabolism. We investigated the duration ...of the sedation and additional anesthetic needs during magnetic resonance imaging in epileptic children receiving antiepileptic drugs that cause either enzyme induction or inhibition.
In American Society of Anesthesiology I–II, 120 children aged 3–10 years were included. Group 1: children using antiepileptic drugs that cause cytochrome P450 enzyme induction; Group 2: those using antiepileptic drugs that cause inhibition; and Group 3: those that did not use antiepileptic drugs. Sedation was induced with the use of 0.05mgkg−1 midazolam and 1mgkg−1 propofol. An additional 0.05mgkg−1 of midazolam and rescue propofol (0.5mgkg−1) were administered and repeated to maintain sedation. The duration of sedation and the additional sedation needed were compared.
The duration of the initial dose was significantly shorter in Group I compared with groups II and III (p=0.001, p=0.003, respectively). It was significantly longer in Group II compared with groups I and III (p=0.001, p=0.029, respectively). The additional midazolam needed for adequate sedation was increased in Group I when compared with groups II and III (p=0.010, p=0.001, respectively). In addition, the rescue propofol dose was significantly higher only in Group I when compared with Group III (p=0.002).
In epileptic children, the response variability to the initial sedative agents during the magnetic resonance imaging procedure resulting from the inhibition or induction of the cytochrome P450 isoenzymes by the antiepileptic drugs mandated the titration of anesthetic agents.
A indução e a inibição das isoenzimas do citocromo P450 pelos medicamentos antiepilépticos levam a alterações na depuração de medicamentos anestésicos eliminados pelo metabolismo hepático. Investigamos a duração da sedação e a necessidade adicional de anestésicos durante a ressonância magnética em crianças epilépticas que receberam antiepilépticos que causam a indução ou a inibição de enzimas.
Foram incluídas no estudo 120 crianças, estado físico ASA I-II, entre 3-10 anos. Grupo 1: em uso de antiepilépticos que causam a indução de enzimas do citocromo P450; Grupo 2: em uso de antiepilépticos que causam a inibição de enzimas do citocromo P450; e Grupo 3: que não usavam antiepilépticos. A sedação foi induzida com midazolam (0,05mgkg−1) e propofol (1mgkg−1). Um adicional de 0,05mgkg−1 de midazolam e resgate com 0,5mgkg−1 de propofol foram administrados e repetidos para manter a sedação. A duração da sedação e a sedação adicional necessária foram comparadas.
A duração da dose inicial foi significativamente menor no Grupo I em comparação com os grupos II e III (p=0,001, p=0,003, respectivamente) e significativamente maior no Grupo II em comparação com os grupos I e III (p=0,001, p=0,029, respectivamente). A necessidade de midazolam adicional para sedação adequada foi maior no Grupo I em comparação com os grupos II e III (p=0,010, p=0,001, respectivamente). Além disso, a dose de resgate de propofol foi significativamente maior apenas no Grupo I em comparação com o Grupo III (p=0,002).
Em crianças epilépticas, a variabilidade da resposta aos agentes sedativos iniciais durante a ressonância magnética, resultante da inibição ou indução das isoenzimas do citocromo P450 pelos medicamentos antiepiléticos, exigiu a titulação dos agentes anestésicos.
Wars and its challenges have historically afflicted humanity. In Syria, severe injuries occurred due to firearms and explosives used in the war between government forces and civilians for a period of ...over 2 years.
The study included 364 cases, who were admitted to Mustafa Kemal University Hospital, Medicine School (Hatay, Turkey), and underwent surgery. Survivors and non-survivors were compared regarding injury site, injury type and number of transfusions given. The mortality rate found in this study was also compared to those reported in other civil wars.
The mean age was 29 (3-68) years. Major sites of injury included extremities (56.0%), head (20.1%), abdomen (16.2%), vascular structures (4.4%) and thorax (3.3%). Injury types included firearm injury (64.4%), blast injury (34.4%) and miscellaneous injuries (1.2%). Survival rate was 89.6% while mortality rate was 10.4%. A significant difference was observed between mortality rates in this study and those reported for the Bosnia and Lebanon civil wars; and the difference became extremely prominent when compared to mortality rates reported for Vietnam and Afghanistan civil wars.
Among injuries related to war, the highest rate of mortality was observed in head-neck, abdomen and vascular injuries. We believe that the higher mortality rate in the Syrian Civil War, compared to the Bosnia, Vietnam, Lebanon and Afghanistan wars, is due to seeing civilians as a direct target during war.
Abstract During surgery, changes in intraocular pressure (IOP) can be observed resulting from several factors, such as airway manipulations and drugs used. We aimed to investigate the effects of ...sugammadex and neostigmine on IOP, hemodynamic parameters, and complications after extubation. Our study comprised 60 patients, aged 18–65 years, with a risk status of the American Society of Anesthesiologists I–II who underwent arthroscopic surgery under general anesthesia. The patients were randomly assigned into two groups. At the end of the surgery, the neuromuscular block was reversed using neostigmine (50 μg/kg) plus atropine (15 μg/kg) in Group 1, and sugammadex (4 mg/kg) in Group 2. Neuromuscular blockade was monitored using acceleromyography and a train-of-four mode of stimulation. IOP was measured before induction and at 30 seconds, 2 minutes, and 10 minutes after extubation. A Tono-Pen XL applanation tonometer was used to measure IOP. This showed that elevation in IOP of patients reversed using sugammadex was similar to that recorded in patients reversed using neostigmine–atropine. When heart rate was compared, there was a significant difference between basal values and those obtained at 30 seconds and 10 minutes after extubation in the neostigmine–atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group ( p = 0.003) than in the neostigmine–atropine group. The postextubation IOP values of the sugammadex group were similar to the neostigmine–atropine group. Extubation time (time from withdrawal of anesthetic gas to extubation) was significantly shorter in the sugammadex group ( p = 0.003) than in the neostigmine–atropine group.
Summary
Background
Carbon monoxide (CO) is a product of burning solid fuel in stoves and smoking. Exposure to CO may provoke postoperative complications. Furthermore, there appears to be an ...association between COHb concentrations and pain. We thus tested the primary hypothesis that children with high preoperative carboxyhemoglobin (COHb) concentrations have more postoperative complications and pain after tonsillectomies, and secondarily that high‐COHb concentrations are associated with more pain and analgesic use.
Methods
100 children scheduled for elective tonsillectomy were divided into low and high carbon monoxide (CO) exposure groups: COHb ≤3 or ≥4 g·dl−1. We considered a composite of complications during the 7 days after surgery which included bronchospasm, laryngospasm, persistent coughing, desaturation, re‐intubation, hypotension, postoperative bleeding, and reoperation. Pain was evaluated with Wong‐Baker Faces pain scales, and supplemental tramadol use recorded for four postoperative hours.
Results
There were 36 patients in the low‐exposure group COHb 1.8 ± 1.2 g·dl−1, and 64 patients were in the high‐exposure group 6.4 ± 2.1 g·dl−1. Indoor coal‐burning stoves were reported more often by families of the high‐ than low‐COHb children (89% vs 72%, P < 0.001). Second‐hand cigarette smoke exposure was reported by 54% of the families with children with high COHb, but only by 24% of the families of children with low COHb. Composite complications were more common in patients with high COHb 47% vs 14%, P = 0.0001, OR:7.4 (95% Cl, lower = 2.5‐upper = 21.7), with most occurring in the postanesthesia care unit. Pain scores in postanesthesia care unit and one hour after surgery were statistically significantly lower in the low‐exposure group respectively, P = 0.020 (95%CI, lower = −1.21‐upper = −0.80), P = 0.026 (95% CI, lower = −0.03‐upper = 0.70), and tramadol use increased at 4 h (3.5 (interquartile range: 0–8) vs 6 (5–9) mg, P = 0.012) and 24 h (3.5 (0–8) vs 6 (5–9) mg, P = 0.008).
Conclusion
High preoperative COHb concentrations are associated with increased postoperative complications and pain.
PURPOSE:This study aimed to compare the effects of remifentanil and esmolol on the elevation of intraocular pressure (IOP) and hemodynamic response.
METHODS:After approval of the institutional Ethics ...Committee and obtaining informed consent, 60 adult patients with American Society of Anesthesiologists I-II status undergoing elective, nonophthalmic surgery were included in the study. Exclusion criteria were preexisting eye disease, neuromuscular disease, esophageal reflux, hiatus hernia, allergy to any of the study drugs, and the use of β-blockers, diuretics, or other antihypertensive agents. The patients were randomized into 2 groups by using the sealed-envelope method, as followsgroup E (esmolol) and group R (remifentanil). A single intravenous dose of esmolol (0.5 mg/kg) or remifentanil (1 μg/kg) just before induction agents were given to patients in groups E and R, respectively. IOP, heart rate (HR), and mean arterial pressure (MAP) values were recorded before intubation and at 1, 3, 5, and 10 minutes after intubation.
RESULTS:The IOP decrease in group R was statistically significant compared with group E (P<0.01). HR values at 10 minutes after intubation were significantly decreased in group E compared with group R (P<0.05). There was no significant difference in MAP values between the groups.
CONCLUSIONS:It was concluded that remifentanil is more effective than esmolol in preventing IOP elevation related to laryngoscopy and tracheal intubation, while there is no significant difference between the 2 agents in terms of HR and MAP.
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