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Monitored anaesthesia care (MAC) and ophthalmic surgery  [PDF]
BK Bhattarai
Nepalese Journal of Ophthalmology , 2009, DOI: 10.3126/nepjoph.v1i1.3674
Abstract: The use of monitored anaesthesia care (MAC) is increasing with the discovery of newer, more effective and appropriate drugs and techniques. MAC is intended to achieve patient comfort with safety and optimal clinical outcome and is being extensively used worldwide for cataract and other ophthalmic surgeries. This article briefly reviews the conceptual basis of MAC, its use in ophthalmic surgeries, sedative-analgesic drugs commonly used during MAC in eye surgeries, monitoring during MAC in eye surgery and the role of anaesthesia practitioners during MAC. Key words: anaesthesia; cataract; eye; monitored anaesthesia care (MAC); sedation; surgery DOI: 10.3126/nepjoph.v1i1.3674 Nep J Oph 2009;1(1):60-65
An audit of emergency anaesthesia and surgery
SA Eguma, DU Kalba
Nigerian Journal of Surgical Research , 2003,
Abstract: Background: Emergency surgical patients pose problems in initial resuscitation, anaesthetic and surgical management and postoperative care. Lack of basic amenities, scarce financial resources and poor organization of available health resources are factors that negatively influence the quality of surgical care rendered in developing countries. This paper presents findings of an audit of emergency surgical and anaesthetic services provided at the main theatre of the Ahmadu Bello University Teaching Hospital, Kaduna (ABUTHK) in year 2001. Our focus was to survey emergency surgical and anaesthetic services over a twelve-month period in order to evaluate the pattern of presentation and adequacy of management of surgical emergencies. Method: Data collected for all emergencies booked at the ABUTHK main theatre included grade of anaesthetists and operating surgeons, the age, sex and ASA class of patients. Also, the time of booking surgery, actual time of surgery, type of anaesthesia given, immediate outcome of surgery, cases booked but not done and the reasons, were all examined. Analysis of the data relied on simple statistical tables and charts. Results: Three hundred and forty eight patients were booked for emergency surgery within the study period while 331 emergency surgeries were actually performed. The surgery cancellation rate was 4.8%. Young adult females with obstetric emergencies formed the bulk of the patients requiring emergency surgery. 57.7% of emergency surgeries were performed outside normal working hours. Surgical residents handled 66.13% of the emergencies while anaesthetic residents and nurse anaesthetists provided anaesthesia for 96.3% of patients. General anaesthesia was most often given. Emergencies were sometimes delayed or not done due to lack of theatre space, electricity, water, sterile gowns, anaesthetic drugs, investigation results and patients' inability to pay. Conclusion: Provision of a separate daytime emergency theatre, constant electricity and water and a functional health insurance scheme would solve most of the problems encountered. Key Words: Anaesthesia, emergency surgery, daytime emergency theatre, health insurance Nigerian Journal of Surgical Research Vol.5(1&2) 2003: 140-147
Cervical epidural anaesthesia for thyroid surgery  [PDF]
R Khanna,DK Singh
Kathmandu University Medical Journal , 2009, DOI: 10.3126/kumj.v7i3.2731
Abstract: Background: Cervical epidural anaesthesia is a regional anaesthesia technique which has been used for upper limb surgery, upper thoracic wall surgery, carotid artery surgery and neck dissections. Anaesthesia for thyroid surgery can be complicated due to the altered functional status of the thyroid or its large size. Objective: This prospective study was designed to assess the effectiveness and safety of cervical epidural anaesthesia for thyroid surgery. Materials and methods: Cervical epidural anaesthesia was attempted in 9 patients and the results compared with 44 patients who underwent thyroid surgery under conventional general anaesthesia with endotracheal intubation. The epidural catheter was placed in the C7 - T1 vertebral interspace and 10 - 15 ml of 1% Lignocaine with adrenaline was injected. Results: The technique of cervical epidural anaesthesia was successfully used in 8 out of 9 patients in whom it was attempted All patients were maintained in a state of conscious - sedation and effective analgesia was obtained in all 8 patients. There were no significant complications especially those related to diaphragmatic function and cardiovascular stability. In contrast patients undergoing surgery under conventional general anaesthesia had complications related to endotracheal intubation, cardiac arrhythmias and hypotension Conclusion: The technique of cervical epidural anaesthesia should be considered in thyroid patients where difficult endotracheal intubation is anticipated and in those in whom alterations in thyroid functional state make them vulnerable to cardiovascular complications under conventional general anaesthesia.
Botulinum toxin in ophthalmic plastic surgery  [cached]
Naik Milind,Soparkar Charles,Murthy R,Honavar S
Indian Journal of Ophthalmology , 2005,
Abstract: Botulinum toxin chemodenervation has evolved greatly over the past 30 years since its introduction in the 1970s for the management of strabismus. Among ophthalmic plastic surgeons, botulinum toxins are often used as the first line treatment for facial dystonias. These toxins are also efficacious for the temporary management of various other conditions including keratopathies (through so called chemo-tarsorraphy), upper eyelid retraction, orbicularis overaction-induced lower eyelid entropion, gustatory epiphora, Frey′s syndrome, and dynamic facial rhytids such as lateral canthal wrinkles (crow′s feet), glabellar creases and horizontal forehead lines. This article describes the pharmacology, reconstitution techniques and common current applications of botulinum toxins in ophthalmic plastic surgery.
Anaesthesia for Adult Cardiac Patients Undergoing Noncardiac Surgery
Dr. Ajmer Singh
Indian Anaesthetists' Forum , 2000,
Abstract: Patients with cardiac disease presenting for noncardiac surgery are at increased risk of intraoperative complications such as myocardial infarction (MI); cardiac arrhythmias; pulmonary insufficiency, and death. It is well established that the number of patients with cardiac disease presenting for anaesthesia and surgery are on the increase.
Comparison of subtenon anaesthesia with peribulbar anaesthesia for manual small incision cataract surgery  [cached]
Parkar Tasneem,Gogate Parikshit,Deshpande Madan,Adenwala Arif
Indian Journal of Ophthalmology , 2005,
Abstract: Purpose: To compare the safety and efficacy of subtenon anaesthesia with peribulbar anaesthesia in manual small incision cataract surgery using a randomised control clinical trial. Method: One hundred and sixty-eight patients were randomised to subtenon and peribulbar groups with preset criteria after informed consent. All surgeries were performed by four surgeons. Pain during administration of anaesthesia, during surgery and 4 h after surgery was graded on a visual analogue pain scale and compared for both the techniques. Sub-conjuntival haemorrhage, chemosis, akinesia after administration of anaesthesia and positive pressure during surgery were also compared. Patients were followed up for 6 weeks postoperatively. Results: About 146/168 (86.9%) patients completed the six-week follow-up. Thirty-one out of 88 (35.2%) patients of peribulbar group and 62/80(77.5%) of subtenon group experienced no pain during administration of anaesthesia. There was no significant difference in pain during and 4 h after surgery. Subtenon group had slightly more sub-conjunctival haemorrhage. About 57 (64.8%) patients of the peribulbar group had absolute akinesia during surgery as compared to none (0%) in sub-tenon group. There was no difference in intraoperative and postoperative complications and final visual acuity. Conclusion: Sub-tenon anaesthesia is safe and as effective as peribulbar anaesthesia and is more comfortable to the patient at the time of administration.
Surgery of temporomandibular joint under local anaesthesia  [cached]
Gajiwala Kalpesh
Indian Journal of Plastic Surgery , 2008,
Abstract: Temporomandibular joint ankylosis is a debilitating disorder arising from an inability to open the mouth. This leads to poor nutrition, poor dental hygiene, and stunted growth. Anaesthesia, especially general anaesthesia, is very difficult to administer. There is a lack of direct visualization of the vocal cords, tongue fall following relaxation, and an already narrowed passage due to a small mandible, which makes even the blind nasal intubation difficult. There are various techniques described in literature to overcome these challenges, failing which, one needs to do tracheostomy. All the risks of difficult intubation and general anaesthesia can be avoided if the surgery is done under local anaesthesia. A simple but effective method of successful local anaesthesia is described, which allows successful temporomandibular joint reconstruction.
Anaesthesia for noncardiac surgery in children with congenital heart disease  [PDF]
Simi? Du?ica,?uki? Milan,Budi? Ivana,Milojevi? Irina
Srpski Arhiv za Celokupno Lekarstvo , 2011, DOI: 10.2298/sarh1102107s
Abstract: Children with Congenital Heart Disease (CHD) presenting for non-cardiac surgery have various physiological and functional abnormalities and thus pose great challenges to the anaesthesiologist. The principles of anaesthesia are to minimize pathophysiological changes which may upset the complex interaction between systemic and pulmonary vascular resistance. Knowledge of the specific cardiac anatomy, familiarity with the modifications of the cardiorespiratory physiology, the awareness of the potential risks of complications for each individual case are mandatory for the choice of the anaesthesia strategy for each patient. During the preoperative assessment, the risk-benefit ratio should be estimated and preoperative plan established in order to optimize the preoperative status. An anaesthesiologist must also understand pharmacology of drugs being used and should tailor anaesthetic management to the type of surgery. An interdisciplinary team approach is the cornerstone for the safe delivery of anaesthesia to this paediatric patient population. The team should comprise an anesthesiologist, a paediatric cardiologist, a surgeon, a cardio-surgeon and a neonatologist. This review is meant to explain the classification of congenital heart diseases and to equip the anaesthesiologist with the necessary information about preoperative assessment, anaesthesiology management, monitoring tools important for the safe non-cardiac surgery procedures as well as therapeutic strategies during the postoperative period.
Prevention of postoperative infections in ophthalmic surgery  [cached]
Ram Jagat,Kaushik Sushmita,Brar Gagandeep,Taneja Neelam
Indian Journal of Ophthalmology , 2001,
Abstract: Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.
Efficacy of 2 Drops versus 3 Drops Proparacaine 0.5% Ophthalmic Solution for Phacoemulsification Surgery: A Comparative Study  [PDF]
Tanie Natung, Jacqueline Syiem, Avonuo Keditsu, Nilotpal Saikia, Ranendra Hajong, Laura Amanda Lyngdoh
Open Journal of Ophthalmology (OJOph) , 2015, DOI: 10.4236/ojoph.2015.53015
Abstract: Background and Aim: Phacoemulsification surgery with intraocular lens implantation is routinely done under topical anaesthesia in many centres. No comparative study on the efficacy of number of drops of topical anaesthetics effective for phacoemulsification surgery has been done. This study was conducted to compare the efficacy of 2 drops versus 3 drops proparacaine 0.5% ophthalmic solution for phacoemulsification surgery. Methods: Patients with uncomplicated cataract undergoing phacoemulsification surgery were randomised into two groups. Group 1 (n = 53) received 3 drops of proparacaine 0.5% whereas group 2 (n = 47) received 2 drops of the same solution before the start of surgery. All the patients underwent phacoemulsification with foldable intraocular lens implantation. Each patient’s subjective experience of pain was measured using a 10 point Visual Analogue Pain Scale (VAS). Patient’s cooperation during the surgery was assessed using a 3 point score. Both the evaluating resident doctor and patients were blinded. Results: In group 1, 73.6% patients scored 0, 20.8% scored 1 and 5.7% scored 2 of VAS respectively and in group 2, 89.4%, 6.4%, 4.3% patients scored 0, 1 and 2 of VAS respectively. In patient cooperation, 90.1% and 9.4% patients in group 1 scored 1 and 2 respectively whereas 87.2% and 12.8% patients scored 1 and 2 respectively in group 2. No statistically significant difference in the mean VAS (P = 0.0.55) and patient cooperation score (P = 0.597) was found between the two groups. The mean VAS score was 1.24 ± 0.534 and the mean patient cooperation score was 1.11 ± 0.314. The mean total surgical time was 25.11 ± 2.68 minutes. No additional drops were required for either group. Conclusions: Topical anaesthesia with both 2 drops and 3 drops proparacaine 0.5% ophthalmic solution is effective for phacoemulsification with intraocular lens implantation. Additional anaesthesia may be unnecessary in these cases.
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