Oculocardiac reflex during strabismus surgery

The activation of oculucardiac reflex [OCR] is common during the strabismus surgeries. OCR is known as a trigemino-vagal reflex, which leads to the various side effects including bradycardia, arrhythmia, or in some cases cardiac arrest. This reflex could be activated during intraorbital injections, hematomas, and mechanical stimulation of eyeball and extraocular muscles surgeries. The incidence of OCR varies in a wide range, from 14% to 90%, that depends on anesthetic strategy and drug used for the surgery. The efficacy of various anticholinergic and anesthetic agents on declining the OCR reflex has been evaluated in different studies, especially in children. Although the detection of OCR goes back to 1908, its exact effect is not well recognized during strabismus surgery. In this review, we aimed to summarize the studies investigated the efficacy and potential of various anesthetic medications on inhibiting the OCR in children undergoing strabismus surgery

Apneas in infants with postconceptional age bellow 60 weeks undergoing herniorrhaphy

Objective: Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy

Methods: One-hundred fifty infants with post conceptional age [PCA] less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography

Findings: Totally, 31 [20.7%] cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven [18%] apnea cases occurred in recovery room in infants with gestational age [GA] of 35.64+/-2.73 weeks, while only four [2.6%] patients of GA 36.02+/-2.0 weeks developed delayed apnea]

Conclusion: In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients

Accidental intrathecal injection of magnesium sulfate for cesarean section

Magnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg [3.5 ml of 20% solution] was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four [TOF] reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked

Comparison of total intravenous anesthesia [TIVA] with inhalation anesthesia in pediatric bronchoscopy

Because of airway stimulations during bronchoscopy and lack of direct access to the airway, preferred method of anesthesia for rigid bronchoscopy is already controversial. In this study we compared inhalation anesthesia with total intravenous anesthesia [TIVA] for rigid bronchoscopy. 30 patients aged 2-6 years were chosen divided into two same groups. Anesthesia in group I maintained with halothane and in group II maintained with remifentanil and propofol. Oxygenation, heart rate, respiratory rate, coughing, bucking, laryngospasm, bronchospasm were evaluated during and after surgery. Also operation success and surgeon's satisfaction were recorded as well. Demographic findings were the same in both groups. Oxygenation and heart rate were more stable in group II [P=0.047 and P=0.026 respectively] but there was no significant difference in respiratory rate between two groups [P=1]. Success rate was also similar in both groups but surgeon's satisfaction was significantly higher in TIVA [P=0.003]. There was not any significant different between complications in two groups. We suggest TIVA for rigid bronchoscopy because of better oxygenation, more homodynamic stability, surgeon's satisfaction, lack of air pollution and less interference with surgeon's visual field