Comparison of proseal laryngeal mask and endotracheal tube for airway safety in pediatric strabismus surgery

To compare proseal laryngeal mask airway [PLMA] with an endotracheal tube [ET] for airway safety, maintained ease of insertion, and hemodynamic stability in pediatric strabismus surgery [PSS]. This prospective-randomized clinical study was carried out in the Department of Anesthesiology, Faculty of Medicine, Gaziantep University, Turkey between April 2008 and July 2009. Eighty American Society of Anesthesiology [ASA] I-II children, weight 10-30 kg, aged between 1-12 years undergoing PSS were selected. The anesthesia was induced with 8% sevoflurane, 50% nitrous oxide/oxygen mixture, and a neuromuscular blockade with 0.5 mg/kg atracurium in both groups. After a sufficient dosage of anesthesia, the patients were randomized into 2 groups [Group P: PLMA, n= 40, Group T: ET, n=40] and an airway management device; either a PLMA or ET was inserted. The number of placement attempts, placement success or failure, success or failure of a gastric suction tube placement during the procedures and perioperative complications were assessed. Thirty-eight patients [95%] in the PLMA group, 39 [97.5%] patients in the ET group were successfully placed with a PLMA and ET on the first attempt [p>0.05]. There were no statistically significant differences in the hemodynamic parameters, end-tidal carbon dioxide, and complications. This study revealed that PLMA may offer an alternative airway to ET wherein positive pressure ventilation was the preferred choice for children undergoing PSS

Dexmedetomidine use during strabismus surgery in agitated children

We aimed to investigate the effects of dexmedetomidine premedication before intravenous infusion of ketamine in agitated children undergoing strabismus surgery. We enrolled 60 agitated pediatric patients, aged 4.5-11 years. The patients were randomly allocated to one of two anesthesia regimens. Group D patients were premedicated with a single dose of intravenous dexmedetomidine 0.5 mg/kg whereas group P patients received a placebo. Patients in both groups were administered intravenous ketamine 1 mg/kg i.v. over 1 min followed by a continuous infusion of ketamine 1-3 mg/kg/h i.v. [n=30]. Patients were intubated after receiving fentanyl 1 mg/kg and rocuronium bromide 0.5 mg/kg. 21 [70%] patients in group D did not show the oculocardiac reflex [OCR] versus 7 [23%] in group P [p=0.0006]. The preoperative and postoperative agitation scores [p=0.0001 and p=0.03, respectively], the score on the Faces Pain Scale during awakening [3.0 [interquartile range, IQR 2.0-4.0] in group D and 0.0 [IQR 1.0-2.25] in group P] [p=0.001] and at the 60th postoperative minute [IQR 2.0 [1.5-3.0] in group D and 2.0 [IQR 1.5-3.0] in group P] [p=0.004], sore throat [26.6% in group D and 60% in group P] [p=0.01] and analgesic requirement [20% in group D and 53% in group P] [p=0.01] in group P were significantly higher than in group D. The Ramsay Sedation Score [RSS] in group D was significantly higher than in group P during awakening [2.0 [2.0-2.0] in group D and 4.5 [4.0-5.0] in group P] [p=0.0001]. Dexmedetomidine premedication followed by intravenous infusion of ketamine was effective in decreasing OCR, agitation, pain, analgesic requirement in agitated children undergoing strabismus surgery

Ophthalmic manifestations of 107 cases with hemolysis, elevated liver enzymes and low platelet count syndrome

To present various ophthalmologic disorders in a clinical series of hemolysis, elevated liver enzymes and low platelet count [HELLP] syndrome cases. This is a prospective clinical study performed between 2002 and 2005. One hundred seven HELLP patients attended in either Departments of Ophthalmology or Obstetrics and Gynecology, Medical School, Gaziantep University, Gaziantep, Turkey were evaluated. Mean age was 25.5 [22-36 years]. Mean levels were 2.5 gravidity, 1.3 parity, 55,200/mm3 platelet counts, 308.7 U/l aspartate transaminase, 255.4 U/l alanine transaminase, and 1711.6 U/I lactate dehydrogenase. Four patients died [3.7%] despite the proper treatments. Cortical blindness was observed in 3 cases [2.7%], serous retinal detachments in 4 [3.7%], and mild hypertension changes in 18 [16%]. Ophthalmic complications are possible during and after this syndrome. Almost all ophthalmologic changes recover after delivery by cesarean section, nevertheless, it is essential that ophthalmologists should be aware of retinal disorders when this fatal complication of pregnancy is encountered

effect of age and gender on the anatomic structure of Caucasian healthy eyelids

To determine the normal values of the eyelid parameters in Caucasians and to describe the effects of age and gender on eyelid and eyebrow anatomy. We evaluated the effects of age and gender on eyelid structures in 100 Caucasian volunteers in the Ophthalmology and Anatomy Departments, University of Gaziantep Medical School, Turkey between 2003 and 2004. Forty-five females with mean age of 36 years [5-80 years] and 55 males with mean age of 39 years [3-68 years] participated in the study. We divided subjects into 6 groups according to decades. We measured the palpebral fissure length [PFL], the distance between the pupil center and the upper eyelid [PC-UE] and lower eyelid margin [PC-LE], the eyebrow height [EH], the eye crease height [ECH] and the distance from the reference line to the pupil center [RL-PC], using a reference line through the medial canthus and vertical line through the pupil center of the frontal slides. The measurements of PFL were between 23.5 mm and 29 mm in females, 24.8 mm and 29.1 mm in males and showed a gradual decrease with age. The PC-UE, PC-LE, ECH and RL-PC remained stable throughout life and were identical for both gender. However, EH ranging from 10.7 - 12 mm in females and 6.5 - 11 mm in males appeared to have a significant association with gender, which was higher in females than males, but was not effected with age. These results demonstrate the importance of providing a normal anatomic relationship that relates to the patient's age and gender