Sevoflurane versus propofol sedation during periocular anesthetic injections in oculoplastic procedures: an open-label randomized comparison

The purpose of the current investigation was to make an objective controlled comparison of pain tolerance, patient satisfaction and potential complications during the injection of local anesthesia in oculoplastic procedures under short-term sedation using inhalational versus parenteral sedatives. This was an open-label, randomized clinical trial where patients were randomized to 3 groups. Group I: Sedation with intravenous propofol. Group II: Sedation with inhaled sevoflurane. Group 3: Control group receiving no sedation. A total of 396 patients were randomly assigned, and 375 were included in the final analysis. Study groups were similar in age, gender, and distribution of operative procedures performed. There was no statistically significant difference in the adjusted primary composite outcome measure between propofol and sevoflurane [pain scores and patient satisfaction]. Significantly more patients in group I required restraining during periocular injections than group II or III [p < 0.001]. Significantly more patients sneezed in group I than group II [p < 0.001] and none in the control group. Three patients in group II suffered severe excitation-disinhibition during emergence from sedation which was rapidly reversible, and 3 more suffered a severe bout of postoperative nausea and vomiting [PONV]. Sevoflurane and propofol during periocular anesthetic injections produce an equally favorable experience. Sevoflurane is introduced painlessly, and offers better patient control with less induction of the sneezing reflex which may provide a higher safety profile, however short-term aggression/disinhibition and PONV may be an issue in some patients

Computed tomography of the orbit - a review and an update

Computed tomography [CT] and magnetic resonance imaging [MRI] of the orbit have been competing for the hearts and minds of health care providers for well over 2 decades. While several drawbacks pertaining to CT have been outlined since the introduction of MRI, CT remains the standard diagnostic test for evaluating cross-sectional, 2 or 3-dimensional images of the body

Surgically mismanaged ptosis in a patient with congenital fibrosis of the extraocular muscles type I

Fibrosis syndromes comprise a rare form of severe limitation of ocular motility. An 11-year-old girl was referred for the correction of eyelid retraction. The eyelid retraction occurred immediately following levator resection surgery performed by a plastic surgeon who missed the restrictive extraocular muscle abnormalities. On examination, both eyes were fixed in an infraducted position [20 prism diopters [DELTA]], with a chin-up position and significant lagophthalmos. Bilateral 12-mm inferior rectus recession with adjustable sutures was performed, which resulted in significant reduction of lagophthalmos and elimination of the head tilt