ABSTRACT
INTRODUCTION: cataracts preferentially affect the elderly. More than 560,000 procedures are performed annually in France on vulnerable patients that are exposed to cardio-circulatory conditions requiring antiplatelet and/or anticoagulants. Haemorrhagic complications resulting from cataract surgery and/or eye regional anaesthesia are rare but can lead to serious damage to eye function. PATIENTS AND METHODS: in this study, we compared the management care of two types of antiplatelet and/or anticoagulants successively utilizing the following procedure: first, the cessation of antiplatelet agents and anticoagulants were relayed with rapid elimination agents (constituting our reference "before" cohort [November 2004-May 2005]), then the antiplatelet or anticoagulant management was continued without stint according to recent data from literature (constituting our "after" cohort (April 2007-March 2008)). RESULTS: a reference population, consisting of 229 patients, was operated on exclusively with "surgical" sub-Tenon's anaesthesia. A second group, consisting of 178 patients, was operated on using "needle" regional anaesthesia. In both populations, nearly 33% of patients received antiplatelet or anticoagulant treatment. The incidence of subconjonctival haemorrhage occurred more frequently when anticoagulants agents were relayed (33% vs 0%; P<0,05), but there was no significant difference with antiplatelet agents (23% vs 8%; NS). The most common non-bleeding event was Chemosis and related to the type of anaesthetic technique utilized, although not serious it tended to jeopardize surgical comfort (anticoagulants: 35% vs 36% (NS), antiplatelet agents: 38% vs 40%; NS). CONCLUSION: the technical changes do not explain fully that occurrence of the HSC, in patients under anticoagulant treatment, decreased in the second period. The achievement of "needle" regional anaesthesia in the anterior segment eye surgery is a safe technique that does not require stopping antiplatelet treatment or anticoagulation.
Subject(s)
Anesthesia, Conduction/methods , Anterior Eye Segment/surgery , Anticoagulants/adverse effects , Cataract Extraction , Platelet Aggregation Inhibitors/adverse effects , Postoperative Hemorrhage/chemically induced , Postoperative Hemorrhage/epidemiology , Aged , Anticoagulants/therapeutic use , Female , Humans , Injections , Male , Platelet Aggregation Inhibitors/therapeutic use , Prospective StudiesABSTRACT
Gas embolism is well known for a specific subset of surgical interventions. Prevention and early detection are the main objectives of the anesthetic and surgical team. However, it may exceptionally occur during eye surgery with dramatic outcomes. We report the case of a 51-year-old man, ASA physical status 1, who presented a cardiac arrest during an open eye surgery for the extraction of a foreign body with intraocular air injection. Multiple organ failure has not been improved by hyperbaric oxygen therapy and the outcome was fatal.
Subject(s)
Embolism, Air/etiology , Eye Foreign Bodies/surgery , Hemostatic Techniques/adverse effects , Intraoperative Complications/etiology , Accidents, Occupational , Air , Cavernous Sinus , Eye Hemorrhage/therapy , Eye Injuries/surgery , Fatal Outcome , Foramen Ovale, Patent/complications , Heart Arrest/etiology , Humans , Injections , Middle Aged , Multiple Organ Failure/etiology , Retinal VeinABSTRACT
OBJECTIVE: To compare the effects of the laryngeal mask airway (LMA), and the tracheal tube (TT) insertion on intra-ocular pressure (IOP) in eye surgery. STUDY DESIGN: Prospective non-randomized study. PATIENTS: Eighty patients scheduled for eye surgery under general anaesthesia were allocated into either a LMA group (n = 37) or a TT group (n = 43). METHODS: After induction of anaesthesia with propofol, vecuronium and phenoperidine, either a TT or a LMA were inserted. IOP, heart rate (HP) and mean arterial pressure (MAP) were measured before (TO) and after induction (T1), after TT or LMA insertion (20 s:T2, 6 min:T3), and before extubation (T4). RESULTS: The HR, MAP and IOP increased significantly at T2 (compared to T1 but not to T0) in the TT group, for a short time, whereas no significant changes occurred in the LMA group. CONCLUSION: LMA insertion does not elicit significant haemodynamic or IOP changes. Conversely, the TT increases HR, MAP and IOP. These changes can be deleterious in case of emergency surgery for perforating eye injuries. The LMA can be recommended as an alternative to TT in eye surgery, provided security rules are followed, because of the risk of displacement of LMA during surgery.
Subject(s)
Anesthesia, General , Intraocular Pressure , Intubation, Intratracheal , Laryngeal Masks , Adult , Aged , Eye Diseases/surgery , Female , Hemodynamics , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
Clinical and physical data about laryngeal mask use in eye surgery were collected in 57 patients. We observed 4 failures which required endotracheal intubation, 3 leaks during operative field installation, 4 salvations but no laryngeal spasm and no cough. There were no significative differences between body weights in laryngeal mask groups no 3 and no 4. Insufflation pressures of patients without curarisation were more important. The duration of ventilation was not correlated with salivation, leaks or increase of insufflation pressure.
Subject(s)
Eye Diseases/surgery , Laryngeal Masks , Adult , Equipment Failure , Humans , Intraoperative Complications , Prospective StudiesSubject(s)
Anaphylaxis/etiology , Fluorescein Angiography/adverse effects , Aged , Female , Humans , Time FactorsABSTRACT
Authors report one case of death caused by anaphylactic collapsus after a fluorescein angiography. They make a review of all the complications described and particularly insist about the anaphylactic reactions. They conclude on the modalities of treatment.
Subject(s)
Anaphylaxis/immunology , Fluoresceins/adverse effects , Aged , Anaphylaxis/diagnosis , Anaphylaxis/therapy , Female , Fluorescein Angiography/adverse effects , Humans , Risk FactorsABSTRACT
To suppress the risk inherent in laryngeal microsurgery performed with a CO2 laser beam, the authors suggest to use a reinforced silicone endotracheal tube, the cuff of which is protected by a silicone plus aluminium powder shield. The resistance of silicone to fire is augmented during laser shots by a nitrogen flow on the upper side of the shield at the rates of 2 l/min in patients breathing air and 30 l/min in patients give oxygen.
