Systemic adverse events during 2005 phacoemulsifications under monitored anesthesia care: a prospective evaluation.

BACKGROUND: The aim of the study was to evaluate the systemic adverse events triggering on-call anesthesiologist's intervention during 2005 phacoemulsification under topical anesthesia on a day-surgery monitored anesthesia care regimen. METHODS: Adverse events triggering an anesthesiologist call by the attending nurse were registered. Comorbidities (7 categories), age, gender, body mass index, ASA status, length of surgery, time of the day of surgery and operated eye (first/second) were analyzed as potentially predictive factors. Odds Ratios are expressed as OR (95% CI). RESULTS: The anesthesiologist was called in 433 (21.6%) cases: age (5-yr-OR 0.95 [0.91-0.99]), ASA status 3-4 (OR 1.37 [1.02-1.85]), positive neurological history (OR 1.60 [1.06-2.40]), positive psychiatric history (OR 2.56 [1.34-4.93]) and length of surgery (OR 1.03 [1.01-1.06]) were predictive of the anesthesiologist call. Arterial hypertension (10.3%) and agitation (9.5%) were the most frequent adverse events. Age (5-yr-OR 1.27 [1.16-1.38]) and ASA status 3-4 (OR 1.83 [1.30-2.56]) were predictive of arterial hypertension. Age (5-yr-OR 0.80 [0.76-0.85]), positive neurological history (OR 1.86 [1.10-3.14]) and positive psychiatric history (OR 4.48 [2.26-8.88]) were predictive of agitation. Interruption of surgery was never required. CONCLUSION: One-day cataract surgery performed under topical anesthesia with monitored anesthesia care required anesthesiologist intervention in 21.6% of cases, mainly because of agitation or hypertension. Agitation occurred more often in younger patients with neurological or psychiatric comorbidities. Hypertension occurred more often in older patients with higher ASA scores.

Regulation of prostaglandin endoperoxide synthase by cyclic adenosine 3',5'-monophosphate in the in vitro-perfused rat ovary.

The preovulatory regulation of two enzymes in the prostaglandin biosynthetic pathway, prostaglandin endoperoxide synthase (PGS) and prostacyclin synthase (ISN), was examined in granulosa cells and residual tissue of rat ovaries perfused in vitro. Ovaries from rats primed with pregnant mare's serum gonadotropin (20 IU) were perfused for up to 20 h starting the morning of induced proestrus. The amounts of PGS and ISN present were analyzed with immunoblotting techniques. Soluble extracts from granulosa cells and residual ovarian tissues were obtained at different times (0 h, 3 h, 7 h, 12 h) after treatment in vitro with luteinizing hormone (LH, 0.1 microgram/ml) and 3-isobutyl-1-methylxanthine (IBMX; 0.2 mM) and at 7 h in untreated control ovaries or after treatment with forskolin (30 microM) or LH (0.1 microgram/ml). The levels in the perfusion medium of cyclic adenosine 3',5'-monophosphate (cAMP), progesterone, testosterone, and estradiol were measured and the number of ovulations were examined. The levels of PGS after treatment with LH + IBMX increased up to 7 h and remained high at 12 h, a time that is close to the time of ovulation. The increase was more pronounced in the granulosa cells than in the residual tissue. Treatment with forskolin induced synthesis of PGS in granulosa cells, and the levels at 7 h were similar to those after stimulation with LH + IBMX. The levels of PGS were lower in granulosa cells of the group stimulated with LH alone than in granulosa cells from ovaries stimulated with LH + IBMX or forskolin.(ABSTRACT TRUNCATED AT 250 WORDS)