AIM: To check the safety of continuation of oral anticoagulants in ophthalmic procedures requiring a peribulbar anesthesia. ·METHODS: A prospective case control study included 750 patients with oral anticoagulant...AIM: To check the safety of continuation of oral anticoagulants in ophthalmic procedures requiring a peribulbar anesthesia. ·METHODS: A prospective case control study included 750 patients with oral anticoagulants in group A and 750 patients who had never been treated with oral anticoagulant in group B. Hemorrhages were graded as follows: 1) spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2) eyelid ecchymosis involving half of the lid surface area; 3) eyelid ecchymosis all around the eye,no increase in intraocular pressure; 4) retrobulbar hemorrhage with increased intraocular pressure. ·RESULTS: In group A,grade 1 was observed in 13 patients(1.74%) and grade 2 in 2 patients(0.26%). In group B,grade 1 was observed in 12 patients(1.6%) and grade 2 was absent. No 3 or 4 hemorrhage grade was encountered in both groups. There was not significant difference in grade 1 hemorrhage between both groups(P =0.21). ·CONCLUSION: Oral anticoagulants were not associated with a significant increase in potentially sight-threatening local anesthetic complications.展开更多
Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA ...Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.展开更多
Diabetic macular edema(DME)is a common cause of visual impairment in diabetic patients.It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier.The pa...Diabetic macular edema(DME)is a common cause of visual impairment in diabetic patients.It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier.The pathogenesis of DME is multifactorial.Several therapeutic modalities have been proposed for the treatment of DME.Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities,due to anti-inflammatory,anti-vascular endothelial growth factor and anti-proliferative effects.Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME.Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease.Steroid-related side effects include elevated intraocular pressure,cataract,and injection related complications such as endophthalmitis,vitreous hemorrhage,and retinal detachment particularly with intravitreal steroid injections.In order to reduce the risks,complications and frequent dosing of intravitreal steroids,intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.展开更多
AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical record...AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5 y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24 h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment(CD). The initial surgical approach was performed within the first 48 h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD.CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after locoregional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.展开更多
An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block...An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.展开更多
目的探讨Tenon囊下麻醉对对眼压(IOP)以及眼脉动振幅(OPA)的影响。方法随机选择单眼白内障患者30例,患眼施行Tenon囊下麻醉,另眼设为对照。分别于麻醉前以及麻醉后1、10 min采用动态轮廓眼压计(DCT)测量注射眼和对照眼的IOP及OPA值,比...目的探讨Tenon囊下麻醉对对眼压(IOP)以及眼脉动振幅(OPA)的影响。方法随机选择单眼白内障患者30例,患眼施行Tenon囊下麻醉,另眼设为对照。分别于麻醉前以及麻醉后1、10 min采用动态轮廓眼压计(DCT)测量注射眼和对照眼的IOP及OPA值,比较分析麻醉前后IOP和OPA的变化。结果注射利多卡因后注射眼和对照眼的眼压均无明显变化。注射眼OPA值在麻醉后即显著下降,而对照眼在注射后10 min OPA值开始降低。结论Tenon囊下麻醉可导致OPA降低,而对眼压无影响。展开更多
文摘AIM: To check the safety of continuation of oral anticoagulants in ophthalmic procedures requiring a peribulbar anesthesia. ·METHODS: A prospective case control study included 750 patients with oral anticoagulants in group A and 750 patients who had never been treated with oral anticoagulant in group B. Hemorrhages were graded as follows: 1) spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2) eyelid ecchymosis involving half of the lid surface area; 3) eyelid ecchymosis all around the eye,no increase in intraocular pressure; 4) retrobulbar hemorrhage with increased intraocular pressure. ·RESULTS: In group A,grade 1 was observed in 13 patients(1.74%) and grade 2 in 2 patients(0.26%). In group B,grade 1 was observed in 12 patients(1.6%) and grade 2 was absent. No 3 or 4 hemorrhage grade was encountered in both groups. There was not significant difference in grade 1 hemorrhage between both groups(P =0.21). ·CONCLUSION: Oral anticoagulants were not associated with a significant increase in potentially sight-threatening local anesthetic complications.
文摘Background and aims: we aimed to detect the outcome values of adding fentanyl, dexamethasone and sodium bicarbonate to mixture of local anesthetic in peribulbar block for vitreoretinal surgery. Methods: 120 adult ASA I & II patients, admitted for vitreoretinal surgery under peribulbar block were included in this comparative study. This study included 4 groups: Group I: (30) patients using a mixture of 1 ml normal saline, 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group II: (30) patients using a mixture of 1 ml of sodium bicarbonate (from 1 ml sodium bicarbonate 8.4% diluted in 10 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group III: (30) patients using a mixture of 1 ml fentanyl 20 μg (from a mixture of fentanyl 100 μg diluted in 5 ml normal saline), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. Group IV: (30) patients using a mixture of 1 ml of 4 mg dexamethasone (1 ampoule = 8 mg/2 ml), 4 ml lidocaine 2% plus 4 ml from bupivacaine 0.5% 20 ml vial containing hyaluronidase 1500 IU. We measured the onset and duration of anesthesia, IOP, eyelid and global akinesia, postoperative pain by numerical pain rating scale, first analgesic requirement and postoperative side effects. Results: No significant differences were detected among the four groups as respect to age, sex and the intraocular pressure (IOP) before the anesthesia block. While the intraocular pressure (IOP) after the anesthesia block there was a significant difference, as IOP was markedly decreased postoperatively in group II compared with other groups. As regard to the onset & duration of anesthesia there was significant difference among all groups, there was rapid onset and prolonged duration of anesthesia in group III compared with other groups (1.77 ± 0.63 & 5.03 ± 0.89) respectively. As regard the onset of lid akinesia there was significant difference among the four groups with better outcome in group III, as in group III represented the most rapid onset of lid akinesia. As respecting to the onset of global akinesia there was significant difference among the four groups. There was better outcome in group III as it represented more rapid onset of global akinesia compared with other groups. There were significant differences among the four groups as regard postoperative pain all over 6 hours, better results were in group III (0.27 ± 0.69) compared with group I (2.23 ± 1.17), group II (2.00 ± 1.70), group IV (0.67 ± 0.71). As regarding to the first time for analgesic requirement there were significant differences among groups, there was no request for analgesia with better outcome in group III with increasing need to the analgesic medication in group I compared to group II and group IV. As regard side effects postoperatively there were few side effects in all groups with few numbers of cases in groups III only one patient. Although these differences in number of patients are not significant among the four groups. Conclusion: Addition of sodium bicarbonate to local anesthetic mixture was the best way in lowering the IOP other than other groups and addition of fentanyl to local anesthesia provided more rapid onset and duration of anesthesia, more rapid onset and duration for lid and global akinesia, less pain, less analgesic requirement and minimal side effects than the other groups.
文摘Diabetic macular edema(DME)is a common cause of visual impairment in diabetic patients.It is caused by an increase in the permeability of the perifoveal capillaries and a disruption of the blood retinal-barrier.The pathogenesis of DME is multifactorial.Several therapeutic modalities have been proposed for the treatment of DME.Corticosteroid treatments have emerged as an alternative therapy for persistent DME or refractory to conventional laser photocoagulation and other modalities,due to anti-inflammatory,anti-vascular endothelial growth factor and anti-proliferative effects.Many studies have demonstrated the beneficial therapeutic effect of corticosteroids with improvement to both retinal thickness and visual acuity in short-term on the treatment of DME.Peribulbar and intravitreal injections have been used to deliver steroids for DME with frequent injections due to the chronic and recurrent nature of the disease.Steroid-related side effects include elevated intraocular pressure,cataract,and injection related complications such as endophthalmitis,vitreous hemorrhage,and retinal detachment particularly with intravitreal steroid injections.In order to reduce the risks,complications and frequent dosing of intravitreal steroids,intravitreal implants have been developed recently to provide sustained release of corticosteroids and reduce repeated intravitreal injections for the management of DME.
文摘AIM: To describe prevalence and different clinical signs and management of cases with penetrating eye injuries during loco-regional anesthesia for ophthalmic surgery. METHODS: A retrospective review of clinical records was carried out, identifying cases of globe penetration secondary to peribulbar anesthesia injection during 5 y activity in Centro de Oftalmología Barraquer. RESULTS: A total of 17 460 needle-based ocular anesthesia procedures were performed in our centre and 4 cases of globe penetration were recorded with an estimated prevalence of 0.024%. Globe penetrations were always detected in the first 24 h after surgery. Vitreous haemorrhage was found in all the cases. Two eyes presented retinal detachment and two eyes choroidal detachment(CD). The initial surgical approach was performed within the first 48 h. Silicone oil was used as tamponade in three eyes and the fourth case remained only with air. Detachments were solved successfully in all the cases. Functional results varied among cases, depending on ocular remarkable antecedent and globe penetration with or without retinal or CD.CONCLUSION: Prevalence of globe penetration during loco-regional anesthesia is low in our centre. Physicians should consider the possibility of globe penetration in eyes with postoperative atypical appearance after locoregional anesthesia. Immediate B-scan ultrasonography is recommended in suspicious cases with a dense vitreous haemorrhage. An early vitrectomy surgery in conjunction with laser or cryotherapy at the penetration sites is essential for good anatomical and functional results.
文摘An 80 years old, bronchial asthmatic, male was posted for left cataract extraction with intra ocular lens implantation. He was administered peribulbar block/left facial nerve block. There was no sensory or motor block. Thereafter peribulbar block was repeated. Only partial akinesia was achieved, so under intermittent intra venous sedation, the surgery continued for 40 minutes. In the post-operative period, no signs of any residual/delayed block were noted. On specific enquiry, patient gave history of scorpion bite thrice, at the age of 27 years on his right foot, about 8-9 years back and again about 6-7 months back on his right hand. On 4th post-operative day after obtaining informed consent, local infiltration of the skin on the ventral aspect of the forearm, using, 6 mL, 2% lignocaine with adrenaline, was carried out. Confirming the suspicion, there was no sensory block after the injection, confirmed by pin prick method. Peribulbar block produces adequate intra-operative analgesia for cataract extraction. The cause of the failures may be due to technical inability to achieve block. However failure that occurs despite of technically correct injection of the correct drug can be mystifying. As the scorpion venom is known to affect the pumping mechanism of sodium channels in the nerve fibres, which are involved in the mechanism of action of local anaesthetic drugs, it may be responsible for the development of “resistance” to the action of local anaesthetic agents.
文摘目的探讨Tenon囊下麻醉对对眼压(IOP)以及眼脉动振幅(OPA)的影响。方法随机选择单眼白内障患者30例,患眼施行Tenon囊下麻醉,另眼设为对照。分别于麻醉前以及麻醉后1、10 min采用动态轮廓眼压计(DCT)测量注射眼和对照眼的IOP及OPA值,比较分析麻醉前后IOP和OPA的变化。结果注射利多卡因后注射眼和对照眼的眼压均无明显变化。注射眼OPA值在麻醉后即显著下降,而对照眼在注射后10 min OPA值开始降低。结论Tenon囊下麻醉可导致OPA降低,而对眼压无影响。
