Introduction: To report by using topical anesthesia for standing phacoemulsification and intraocular lens implantation for two patients who need cataract extraction but unable to lie flat with marked cervical kyphosis...Introduction: To report by using topical anesthesia for standing phacoemulsification and intraocular lens implantation for two patients who need cataract extraction but unable to lie flat with marked cervical kyphosis due to long-standing ankylosing spondylitis and chronic uveitis. Methods: Two patients are unable to lie flat respectively during phacoemulsification underwent this technique in Jingdong and Tonghai county Hospital of Yunnan province in China. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. Results: The intraoperative and postoperative periods were uneventful in two patients, with good visual outcomes after surgery. Conclusion: This technique is valuable for situations where the patient requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.展开更多
AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were ra...AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.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
文摘Introduction: To report by using topical anesthesia for standing phacoemulsification and intraocular lens implantation for two patients who need cataract extraction but unable to lie flat with marked cervical kyphosis due to long-standing ankylosing spondylitis and chronic uveitis. Methods: Two patients are unable to lie flat respectively during phacoemulsification underwent this technique in Jingdong and Tonghai county Hospital of Yunnan province in China. Each patient was positioned erect or semirecumbent in a standard reclining cataract surgical chair. The ceiling-mounted microscope was rotated 60 degrees from the vertical to point toward the patient. Results: The intraoperative and postoperative periods were uneventful in two patients, with good visual outcomes after surgery. Conclusion: This technique is valuable for situations where the patient requires upright positioning because of the inability to recline flat, and should be considered for cases where standard surgical positioning is not possible.
基金National Natural Science Foundation of China (No.39580683)
文摘AIM: To compare the effect of propofol versus urapidil on hemodynamics and intraocular pressure during anesthesia and extubation for ophthalmic patients. METHODS: Eighty-two surgical patients (Class: ASA I-II) were randomly assigned to propofol (n = 41) and urapidil groups (n = 41). Their gender, age, body mass, operation time and dosage of anesthetics had no significant difference between the two groups (P > 0.05). The patients of propofol and urapidil groups were given propofol (1.5mg/kg) and urapidil (2.5mg/kg) respectively; and two drugs were all diluted with normal saline to 8mL. Then the drugs were given to patients by slow intravenous injection. After treatment, the patients were conducted immediate suction, tracheal extubation, and then patients wore oxygen masks for 10 minutes. By double-blind methods, before the induction medication, at the suction, and 5, 10 minutes after the extubation, we recorded the systolic and diastolic blood pressure (BP), heart rate (HR), pH, PaO2, PaCO2, SaO(2) and intraocular pressure (TOP) respectively. The complete recovery time of the patients with restlessness (on the command they could open eyes and shaking hands) was also recorded during the extubation. The data were analyzed by using a professional SPSS 15.0 statistical software. RESULTS: The incidence of cough, restlessness and glossocoma was significantly lower in the propofol group than that in the urapidil group after extubation (P < 0.05). There were no episodes of hypotension, laryngospasm, or severe respiratory depression. There was no statistical difference in recovery time between two groups (P > 0.05). In propofol group, the BP and HR during extubation and thereafter had no significant difference compared with those before induction, while they were significantly lower than those before giving propofol (P < 0.05), and had significant difference compared with those in urapidil group (P < 0.05). Compared to preinduction, the BP of urapidil group showed no obvious increase during aspiration and extubation. The HR of urapidil group had little changes after being given urapidil, and it was obviously increased compared with that before induction. The stimulation of aspiration and extubation caused less cough and agitation in propofol group than that in urapidil group (P < 0.05). The IOP of propofol group showed no obvious increase during extubation compared with that in preinduction, while in the urpidil group, extubation caused IOP significantly increased (P < 0.05). The changes in these indicators between the two groups had no significant difference (P > 0.05). CONCLUSION: Compared to urapidil, propofol is superior for preventing the cardiovascular and stress responses and IOP increases during emergence and extubation for the ophthalmic patients. Moreover, it has no effects on patient's recovery.
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.
