Criofacoemulsificación en la cirugía de catarata / Cryophacoemulsification in cataract surgery

Objetivo: Demostrar los resultados de la criofacoemulsificación en la cirugía de catarata, como una mejora en la calidad visual y de vida de los pacientes. Métodos: Se realizó un estudio prospectivo y analítico de serie de casos en 43 ojos con catarata. Se utilizaron técnicas estadísticas descriptivas como media y desviación estándar. En los resultados no comparados la prueba de chi cuadrado, con significación del 95 por ciento y un valor de p < 0,05 se consideró estadísticamente significativa. Resultados: El 67,44 por ciento de los pacientes no sintieron dolor y lo refirieron muy leve en la colocación del blefaróstato, en la incisión por córnea clara y durante la colocación del lente intraocular; el 62,79 por ciento fueron féminas, mayores de 70 años; el 51,16 por ciento tenía dureza nuclear NO3 por LOCSIII; la visión de colores mejoró en el 90,70 por ciento; la sensibilidad al contraste mejoró en el 58,14 por ciento; el cilindro refractivo en el 72,09 por ciento fue menor de 0,5 dioptrías; la agudeza visual mejor corregida en el 93,02 por ciento fue de 0,8 a 1,0; la paquimetría demostró diferencias significativas al final; la pérdida celular endotelial media fue de 274,16 cel. /mm2; la hexagonalidad media se redujo en un 3,42 por ciento y la encuesta FV-14 fue muy buena en el 100 por ciento de los pacientes al mes de operado. Conclusiones: La criofacoemulsificación es segura y efectiva, que disminuye los efectos inflamatorios de la cirugía sobre la córnea, con alto grado de satisfacción de los pacientes(AU)

ABSTRACT Objective: Demonstrate the effect of cryophacoemulsification in cataract surgery as a way to improve patient visual quality and quality of life. Methods: An analytical prospective study was conducted of a case series of 43 eyes with cataract. Statistical analysis was based on mean and standard deviation descriptive techniques. In results not compared, a chi-square test with 95 percent significance and p < 0.05 was considered to be statistically significant. Results: Of the patients studied, 67.44 percent did not feel any pain and reported very mild pain during blepharostat placement, clear corneal incision and intraocular lens placement; 62.79 percent were females aged over 70 years; 51.16 percent had NO3 nuclear hardness by LOCSIII; color vision improved in 90.70 percent; contrast sensitivity improved in 58.14 percent; in 72.09 percent the refractive cylinder was smaller than 0.5 diopters; in 93.02 percent best corrected visual acuity was 0.8-1.0; pachymetry showed significant differences at the end; mean endothelial cell loss was 274.16 cel/mm2; mean hexagonality was reduced 3.42 percent, and the VF-14 index was very good in 100 percent of the patients one month after surgery. Conclusions: Cryophacoemulsification is safe and effective, reduces the inflammatory effects of surgery on the cornea and achieves a high level of patient satisfaction(AU)

Desarrollo de la anestesia en Oftalmología / Development of anesthesia in Ophthalmology

RESUMEN Para el ser humano la información suministrada por sus ojos resulta esencial en su interacción con el entorno. Por esta razón todos consideramos la vista como nuestro sentido más valioso. Es fácil comprender, por tanto, que cualquier individuo sometido a una operación oftalmológica desarrollará un alto grado de ansiedad; de ahí la importancia de su cooperación para evitar las complicaciones quirúrgicas, donde en muchas ocasiones la cirugía se realiza con anestesia local. Es por eso que evitar el dolor y abolir los movimientos oculares va a ser un paso previo fundamental en la cirugía. Con el advenimiento del desarrollo tecnológico aplicado a la Oftalmología, nuevos procedimientos quirúrgicos persiguen una recuperación visual y social temprana de los pacientes. Dentro de ellos la cirugía de catarata por facoemulsificación exige métodos anestésicos que permitan lograr este propósito, y en la actualidad ya podemos mencionar la anestesia tópica y la crioanalgesia como avances en este sentido, las cuales se aplican en el Instituto Cubano de Oftalmología "Ramón Pando Ferrer". Se realizó una búsqueda de diversos artículos publicados en la plataforma de PubMed, con el objetivo de conocer el desarrollo y las características de los anestésicos aplicados en la cirugía de catarata(AU)

ABSTRACT The information obtained by human beings through their eyes is essential for their interaction with the environment. This is the reason why we all consider our sight as our most valuable sense. It is thus easy to understand that any individual undergoing eye surgery will develop a high degree of anxiety. Hence the importance of their cooperation to prevent surgical complications, since on many occasions surgery is performed with local anesthesia. Preventing pain and stopping eye movement are therefore a crucial previous step in surgery. With the application of technological development to ophthalmology, new surgical procedures have emerged aimed at the patients' visual recovery and early social reincorporation. One of those procedures is phacoemulsification cataract surgery, which requires anesthetic methods that make it possible to achieve such an end. Examples of advances in this field are topical anesthesia and cryoanalgesia, both of which are applied at Ramón Pando Ferrer Cuban Institute of Ophthalmology. A search was conducted for papers published on the PubMed platform with the purpose of becoming acquainted with the development and characteristics of the anesthetics used in cataract surgery(AU)

Avances de la crioanalgesia en la facoemulsificación / Advances of the cryonalgesia in phacoemulsification

Objetivo: Describir los resultados de la aplicación de la crioanalgesia en la cirugía de catarata por facoemulsificación bilateral simultánea en pacientes portadores de catarata, con historia de reacciones alérgicas a los anestésicos farmacológicos. Métodos: Se realizó un estudio descriptivo de serie de casos en un grupo de 10 pacientes con historias de reacciones alérgicas a los anestésicos farmacológicos empleados para la cirugía de catarata. En todos los casos se les efectuó facoemulsificación bilateral simultánea por la técnica de prechop en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer, por vía córnea clara temporal, con irrigación de solución salina balanceada y viscoelásticos a 4 °C. Resultados: No se encontraron diferencias en el sexo; la edad media fue de 62,3 años; la dureza del cristalino, según LOCS III, se encontraba en su mayoría entre opacidades nucleares de II a IV; el tiempo efectivo del ultrasonido no fue superior a medio minuto; todos recuperaron su mejor agudeza visual corregida y no se reportaron complicaciones. El conteo celular endotelial reportó una pérdida de 3,5 % en relación con el conteo inicial preoperatorio. Conclusiones: La crioanalgesia en la facoemulsificación, con una técnica quirúrgica depurada en cirujanos con experiencia, es segura y efectiva con resultados visuales similares a los obtenidos en pacientes operados de catarata por la técnica de facoemulsificación con anestesia farmacológica(AU)

Objective: To describe the results of the application of cryoanalgesia in the cataract surgery using simultaneous bilateral phacoemulsification in patients with a history of allergic reactions to pharmacological anesthesics. Methods: A descriptive case series study was performed in 10 patients with histories of allergic reactions to pharmacological anesthetics that are used in the cataract surgery. All these patients underwent Prechop technique-based simultaneous bilateral phacoemulsification through temporal clear cornea, with irrigation of balanced saline solution and viscoelastic substances at 4 °C in the Center of Ocular Microsurgery of Ramon Pando Ferrer Cuban Institute of Ophthalmology. Results: No differences were found between sexes; the average age was 62.3 years; the crystalline lens hardness, according to LOCS III mostly presented with nuclear opacities ranging II to IV; the effective ultrasound time did not exceed half a minute. All these patients recovered their best corrected visual acuity and no complications were reported. The endothelial cell count showed a loss of 3.5 % when compared with the preoperative initial count. Conclusions: Cryoanalgesia in phacoemulsification, with the use of refined surgical technique by experienced surgeons, is safe and effective with visual results similar to those achieved in patients operated on of cataract through phacoemulsification with pharmacological anesthetic(AU)

Ultrasound-guided percutaneous cryoneurolysis providing postoperative analgesia lasting many weeks following a single administration: a replacement for continuous peripheral nerve blocks?: a case report / 대한마취과학회지

Cryoneurolysis entails using low temperatures to reversibly ablate nerves, with a subsequent analgesia duration measured in weeks or months. Previously, clinical applications for acute pain were limited because treatment originally required exposing the target nerve surgically. However, three developments have now made it possible to provide prolonged postoperative analgesia by cryoneurolysis: 1) new portable, hand-held cryoneurolysis devices, 2) ultrasound machine proliferation, and, 3) anesthesiologists trained in ultrasound-guided peripheral nerve block administration. This report is the first to describe the use of a single preoperative administration of ultrasound-guided percutaneous cryoneurolysis to provide multiple weeks of analgesia following shoulder rotator cuff repair and total knee arthroplasty. Considering the significant benefits of cryoanalgesia relative to continuous peripheral nerve blocks (e.g., lack of catheter/pump care, extremely long duration), this analgesic modality may be a practical alternative for the treatment of prolonged post-surgical pain in a select group of surgical patients.

Cryosurgery in the treatment of oro-facial lesions.

Cryosurgery is a therapeutical method that uses freezing to obtain a tissue inflammatory and/or a destructive response. It has been successfully used for many cutaneous conditions. Its use is increasing for several conditions in the oral cavity. The oral mucosa, because of its characteristics of humidity and smoothness, is an ideal site for this technique. It shows a very good esthetic result and it may be either the first choice or an alternative option to conventional surgery. This article strives to review the modus operandi of cryosurgical instruments, the various indications, limitations and advantages of cryosurgery in the treatment of oral lesions.

Cryoanalgesia of intercostals nerves for relieving postthoracotomy pain and stress reaction / 解放军医学杂志

Objective To study the clinical significance of cryoanalgesia of intercostals nerves for relieving the chest pain and the stress after thoracotomy. Methods 166 patients undergone post-lateral thoracotomy were enrolled for study, including 107 cases of cryoanalgesia of intercostals nerves as cryo-group and 59 cases of non-cryoanalgesia as control group. The patients who had exploratory thoracotomy were excluded. The visual analogue scales (VAS), dosage of dolantin as well as the plasma levels of cortisol and ?-endorphin, and the complications after operation between the two groups were compared and analyzed. Results After operation, the VAS of cryo-group was much lower than that of control group for 7 days, so did the dosage of dolantin during the first 3 days. The complications in the control group were much more than that in the cryo-group who had lower levels of cortisol and ?-endorphin in plasma. Conclusion Cryoanalgesia of intercostals nerves was proved to be a simple, inexpensive, safe form for relieving post-thoracotomy pain. It could not only dramatically relieve the pain and stress level, but also reduce the risk of complications especially in elderly patients.

The Comparison of Cryoanalgesia and Epidural Analgesia in Thoracotomy / 대한마취과학회지

BACKGROUND: Cryoanalgesia provides postoperative analgesia following thoracotomy without serious complications compared with epidural analgesia, but little data indicates which one is better in terms of postoperative analgesia, side effects or associated complications. METHODS: Forty patients undergoing lateral thoracotomy, were randomized to receive a mixture of fentanyl and 0.15% bupivacaine at 0.5 microgram/kg/h of fentanyl via thoracic epidural catheter (Group E) or cryotherapy on the 4th, 5th, 6th, or 7th intercostal nerves using Frigitronics (Group C). Postoperative pain was assessed everyday for 7 days after the thoracotomy by a visual analog scale (VAS). The side effects and patient satisfaction of analgesia were assessed by a system of 4 grades. RESULTS: The VAS scores at rest in group C were significantly higher than those in group E. There was no side effect except numbness in group C, which continued for 3 months on the average. The incidences of side effects (nausea, vomiting, pruritus, sedation, urinary retention) were 15-35% in group E. The 35% of patients in group C were satisfied with postoperative analgesia compared with 95% in group E (P < 0.05). CONCLUSIONS: Epidural fentanyl provided a better analgesic effect than cryoanalgesia for thoracotomy, but there is a clinical advantage in cryoanalgesia over epidural fentanyl with respect to incidences of serious side effects not including. (Korean J Anesthesiol 2000; 39: 83-90)

CHANGES IN NERVE AFTER FREEZING WITH DIFFERENT TEMPERATURES / 解放军医学杂志

The sciatic nerves of rabbit were frozen with different temperatures(-20℃,-60℃, -- 100℃, -140℃ and 180℃).The morphology and function of the frozen nerves were examined with light microscopy (HE stain and histochemical thiocholism method), electron microscopy, and short latency sematesthelic evoked potentials(SSEP), sensory conduction velocity(SCV), electromyo-gram(EMG) at various time intervals after freezing. It was showed that there were no changes in morphology and function of nerves after being frozen at -20C. The nerve fibers showed signs of frozen degeneration and lost their conduction function at -60℃. However, the nerves could recover in this group. About one half of the nerve fibres frozen with -100℃ showed Wallerian degeneration, and the time of repair was delayed. But still the regeneration of nerves was complete. Necrosis of nerve fibers occurred immediately after freezing with -140℃ and-180℃. There were destruction of the basement membrane and proliferation of collagen fibers. The results explained the mechanism of cryoanalgesia clinically. We believe that the temperatures lower than -140℃ are optimal for cryoanalgesia.