RESUMO
Local anaesthesia [LA] for trabeculectomy surgery is a useful and flexible method of anaesthesia. Several methods 'local anesthesia have been described. Topical anesthesia has been reported to be a safe and effective alternative to retro bulbar and peribulbar anesthesia. Topical lidocaine jelly is recently been described in trabeculectomy surgery. The precent study was conducted on 60 adult patients between [50-60] years of age, ASA physical status I and II scheduled for elective trabeculectomy surgery. Patients were divided to 3 groups according to the anaesthetic technique used; group I [20 patients] who received sub-Tenon's block, group [20 patients] who received peribulbar block and group III ho received topical lidocaine jelly 2%. Samples for measurement of plasma cortisol were collected store receiving any type of anaesthesia, during surgery and after conclusion of surgery. The efficacy of the block was asessed by visual analogue scale [VAS], and the surgeon satisfaction score. Systolic and diastolic blood pressures and heart rate were recorded preoperatively before anaesthesia, intraoperative and at end of surgery. There was no statistically significant difference between the 3 groups as regards VAS and surgeon satisfaction score. 10% of the patients in lidocaine gelly group required supplemental intravenous anaesthesia impared to 5% of the patients in each of the sub-Tenon's group and the peribulbar groups. Also 10% of the patients in locaine jelly group required supplemental local anaesthesia compared to 0% in the sub-Tenon's group and 5% in the ribulbar group. As regards complications, chemosis occurred 15%, 30% and 0% in the sub-Tenon's, peribulbar and locaine jelly groups respectively. Subconjunctival haemorage only occurred in 20% of the peribulbar group. The heart and plasma cortisol levels were significantly lower in the lidocaine jelly group preoperatively compared to sub-tenon's and peribulbar groups. This could be attributed to e lower degree of anxiety in those patients who expected less fear of the idea of receiving an injection. Thus, topical iocaine jelly 2% proved to be an effective and safe anaesthetic technique for trabeculectomy surgery.
Assuntos
Humanos , Masculino , Feminino , Anestesia Local , Lidocaína , Complicações Pós-Operatórias , Administração TópicaRESUMO
Background: Hydroxyethyl starch [HES] and Haemagel [Gelatin] may affect blood coagulation, platelet aggregation and renal functions. Our aim is to select which of them is better when given in large doses [> 20 mg/kg] for replacement of losses in patients undergoing major abdominal surgery
Methods: Patients were allocated randomly to receive Haemagel 4% [n=20], or HES 6% [Hestril] [n=20]. The infusion was started after induction of anesthesia and continued until the 1[st] postoperative day to maintain central venous pressure between 8 and 12 mmHg. Prothrombin concentration, thrombin time, platelet count and activated partial thromboplastin time for coagulation assessment, platelet aggregation for platelet function and creatinine clearance for renal function. Measurements were performed after induction of anesthesia [T0], 2 hours intraoperatively [T1], at the end of surgery [T2], 6 hours after surgery [T3] and on the morning, of postoperative day after surgery [T4]
Results: Significantly more HES 6% than Haemagel 4% was given. Blood loss was greatest in the HES group than Haemagel group. Coagulation measurements were significantly affected at the 2[nd] hour intraoperatively, end of surgery, 6 hours after surgery and on the first postoperative day in HES group than Haemagel group. Platelet aggregation was significantly inhibited in both groups compared to base line [T0]. In between groups platelet aggregation was significantly inhibited more in HES group compared to Haemagel group [p value < 0.05] at T1, T2, T3 and returned to near base line values at T4. Renal function investigated by creatinine clearance was significantly decreased in HES group compared to Haemagel group
Conclusion: HES 6% adversely affected measures of platelet function, coagulation parameters and renal functions significantly more compared to Haemagel 4% when given in large amounts [>20 ml/Kg] in patients undergoing major abdominal surgery. Beside the relative less cost of Haemgel compared to HES group. In conclusion the use of Haemagel colloid for blood loss replacement is safer and costs less than other available colloids