Comparing the preventive effect of 2 percent topical lidocaine and intravenous atropine on oculocardiac reflex in ophthalmological surgeries under general anesthesia

The current study aimed to determine preventive effect of 2 percent topical xylocaine on oculocardiac reflex in ophthalmological surgeries except strabismus, including retinal detachment and vitrectomy with scleral buckling under general anesthesia. A randomized controlled clinical trial was carried out on 150 patients aged 18-90 years undergoing ophthalmological surgeries under general anesthesia. Samples randomly divided into the experimental group [received four drops of 2 percent topical xylocaine instilled in desired eye] and control group [received 0.5 mg atropine sulfate injection]. Systolic, diastolic and mean arterial blood pressure of patients and baseline heart rate were recorded. They were compared regarding the incidence of bradycardia, heart rate less than 60 beats/minute, hypotension and blood pressure less than 90 mm/Hg. Data were analyzed by Statistical Package for the Social Sciences software version 20 using Chi-square and ANOVA. The difference between two groups was not statistically significant regarding demographic and basic variables. The incidence of bradycardia in both groups was respectively [90.7 percent vs. 17.3 percent], heart rate less than 60 beats/minute [40 percent vs. 13.3 percent], hypotension [76 percent vs. 32 percent] and blood pressure less than 90 mmHg was [28 percent vs. 8 percent]. Accordingly, the differences between both groups were statistically significant [P > 0.001]. The preventive impact of topical xylocaine upon oculocardiac reflex in ophthalmological surgeries such as retinal detachment and vitrectomy with scleral buckling under general anesthesia was less effective than that of atropine injection. Therefore, to avoid this reflex in high risk patients, injecting atropine would be safer.

O eletrocardiograma em outras situações de grande impacto clínico / The electrocardiogram in great impact clinical setting

Apesar de ter completado 100 anos de existência, o eletrocardiograma ainda é o primeiro exame complementar solicitado para avaliação cardiológica de um paciente. A incorporação de modernos recursos da eletrônica e da informática desenvolveu muito os eletrocardiográfos, mas as bases do registro do sinal elétrico emitido pelo coração permanecem as mesmas. Entretanto, ao longo do século XX, os conhecimentos adquiridos a partir do eletrocardiograma não permaneceram estáticos. A eletrofisiologia clínica contribuiu muito para elucidar os mecanismos das arritmias cardíacas. O reconhecimento de novas doenças diagnosticáveis apenas pelo eletrocardiograma, como as síndromes do QT longo e de Brugada, causadas por modificações genéticas dos canais iônicos, transformou o eletrocardiograma em mensageiro molecular das células do coração. No infarto agudo do miocárdio, estudos baseados em evidências...

Anesthesia for third ventriculostomy-a report of 128 cases

Endoscopic third ventriculostomy [ETV] has become the standard surgical procedure for treatment of non-communicating hydrocephalus. The aim of this study is to report our results over the past ten years with reference to perioperative complications of ETV with a review of some specific anesthetic issues. The computerized database [in the Department of Neurosurgery] and the medical records of 128 patients who underwent ETV between February 1998 and February 2007 at our Hospital, were reviewed. Data collected were, age, sex, weight, height, preoperative biochemical analysis, duration of the procedure, anesthetic drugs used, amount of irrigation fluid used, blood loss, postoperative biochemical analysis and perioperative complications. Preoperative biochemical analysis for all patients was within normal ranges. Normal saline 0.9% was used as irrigation fluid for all patients. The volume during the procedure used ranged from 2 to 6 L [mean 3 L]. When correlating postoperative serum sodium mean values to the volume of irrigation fluid used, it showed non significant correlation [r = 0.07]. Serum potassium level has shown significant decrease postoperatively compared to preoperative levels [P <0.05]. The other biochemical analysis parameters showed non-significant changes postoperatively compared to preoperative data [P > 0.05]. Anesthesiologists should be aware of the intra and postoperative complications secondary to ETV. Intraoperative bradycardia is the commonest arrhythmia occuring during the procedure. Precautions, like alerting the surgeon and pulling out the scope, are enough to revert bradycardia if it occurs. Though postoperative electrolyte imbalance occurs we believe it has no clinical significance. We believe that either normal saline or lactated Ringer solutions could be safely used for intraoperative irrigation with minimal postoperative impact. Though the procedure is a minimally invasive procedure, close observation of vital signs, serum electrolytes as well as volume and temperature of the irrigation fluid and close communication between anesthesiologist and surgeon, are prerequisites for better outcome