Orbital Apex Syndrome – A Case Report

Orbital apex syndrome is characterized by vision loss and ophthalmoplegia due to the involvement of the orbital apex. The signs and symptoms vary depending upon the involvement of the structures within the orbital apex, the superior orbital fissure or the cavernous sinus. Clinical evaluation is the key to the diagnosis which is aided by neuro-imaging modalities including brain and orbital Magnetic Resonance Imaging and Computed Tomography scans. In rare instances, a biopsy may be needed to aid in diagnosis. Treatment depends on what the nature of the lesion.

A Rare Case of Posterior Ischemic Optic Neuropathy after Appendicectomy

Ischemic optic neuropathy is classified into anterior and posterior ischemic optic neuropathy depending upon the part of optic nerve involved. In anterior optic neuropathy, optic nerve head is involved and in posterior ischemic optic neuropathy(PION) retrobulbar portion is involved. There is sudden loss of vision in both the entities but there are optic disc changes in anterior optic neuropathy while in posterior ischemic optic neuropathy optic disc is normal initially. Etiologically, posterior ischemic optic neuropathy is divided into non arteritic non-surgical, arteritic and perioperative non arteritic posterior ischemic optic neuropathy.

Analgesic efficacy of dexmedetomidine versus fentanyl as an adjunct to thoracic epidural in patients undergoing upper abdominal surgery: a randomized controlled trial

Background: This randomised, double-blind study was designed to assess the analgesic efficacy of dexmedetomidine as compared with fentanyl as an adjunct to local anaesthetic in thoracic epidural for upper abdominal surgeries. Methods: Forty adult patients of American Society of Anesthesiologists grade I­II undergoing upper abdominal surgery were randomly allocated into two groups to receive 50 µg fentanyl or 50 µg dexmedetomidine as an adjunct to 10 ml 0.125% bupivacaine via thoracic epidural. Anaesthesia was induced with morphine, propofol and vecuronium and maintained by isoflurane with 60% nitrous oxide in oxygen. In the postoperative period patient-controlled analgesic pumps were used to deliver similar types of mixtures via the epidural catheter. Patients were evaluated for rescue analgesic requirements, haemodynamic stability, postoperative pain, sedation and any adverse events. Results: The groups were comparable regarding intraoperative analgesic requirements, recovery times and postoperative pain scores. The total consumption of rescue analgesia was significantly less in the dexmedetomidine group as compared with the fentanyl group (p = 0.049). Two patients in the fentanyl group had vomiting and one had pruritus. None of the patients had bradycardia, hypotension, excessive sedation or respiratory depression. Patients receiving epidural dexmedetomidine were more satisfied with the technique than those receiving fentanyl (p < 0.001). Conclusion: It was concluded that the addition of dexmedetomidine with 0.125% bupivacaine in thoracic epidural provides effective perioperative analgesia with greater patient satisfaction compared with fentanyl

Comparative study of low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy - A randomised controlled trial.

Introduction: Standard pressure pneumoperitoneum for laparoscopic cholecystectomy employs a pressure range of 12-14 mm Hg. An emerging trend has been the use of low pressure pneumoperitoneum in the range of 7-10 mm Hg in an attempt to lower the impact of pneumoperitoneum on the human physiology while providing adequate working space. Our study proposes to compare the use of low pressure pneumoperitoneum with the use of standard pressure pneumoperitoneum. Methods: A randomised controlled trial consisting of 60 patients with symptomatic gallstone disease who underwent laparoscopic cholecystectomy, of which 30 patients were subjected to standard pressure pneumoperitoneum during the procedure and 30 patients to low pressure pneumoperitoneum. Results: Both groups were comparable in all aspects. The mean operating time with low pressure pneumoperitoneum was 49.07 ± 5.72 minutes and with standard pressure pneumoperitoneum was 46.43 ± 6.92 minutes. There was no statistically significant change in blood pressure, heart rate, pain at 6 hours, need for additional analgesia or shoulder tip pain with the use of lower pressure pneumoperitoneum. Conclusions: Low pressure pneumoperitoneum benefits the patient in the form of lower intensity of postoperative pain but it does not positively impact intraoperative hemodynamics.