ABSTRACT
1. The eye is made up of three layers: the retina, uveal tract, and sclera, which is continuous with the cornea. 2. Drugs are used during surgery to achieve specific effects. Nonsteroidal anti-inflammatory drugs reduce irritation and maintain the dilation effect of cycloplegics and mydriatics. Viscoelastic substances protect the nonregenerative endothelial cells. 3. The risks involved with cataract surgery include hemorrhage in the anterior chamber, a tear in the posterior capsule, and damage to the endothelial cells and retina.
Subject(s)
Cataract Extraction/methods , Cataract Extraction/adverse effects , Cataract Extraction/nursing , HumansABSTRACT
Methacholine and citric acid responses were assessed before, during, and after 6 wk of oral treatment with either placebo or methylprednisolone (2 mg.kg-1.day-1) in 12 Basenji-Greyhound dogs. Bronchoalveolar lavage was performed in three dogs in each group before, during, and after pretreatment. Base-line airway resistance and dynamic compliance did not change with treatment in any of the groups. Placebo treatment had no demonstrable effect on methacholine and citric acid responsiveness. Methylprednisolone treatment abolished the constrictor response to citric acid during the 4th and 6th wk of treatment and significantly reduced methacholine responsiveness during the 3rd and 5th wk of treatment. Methylprednisolone treatment was associated with a marked reduction in the percent of eosinophils, but not mast cells, in the bronchoalveolar lavage fluid during the 7th wk. Blood eosinophil counts were also markedly reduced in the methylprednisolone-treated group compared with the placebo-treated group during the 7th wk. The decrease in numbers of eosinophils in blood and bronchoalveolar lavage fluid suggests interference with the inflammatory process as a possible mechanism for the observed reduction in airway hyperresponsiveness in the Basenji-Greyhound dog.
Subject(s)
Asthma/physiopathology , Citrates , Methacholine Compounds , Methylprednisolone/therapeutic use , Aerosols , Animals , Asthma/drug therapy , Citrates/administration & dosage , Disease Models, Animal , Dogs , Female , Leukocyte Count/drug effects , Lung Compliance , Male , Methacholine Compounds/administration & dosage , RespirationABSTRACT
A 30-year-old female patient presented in a comatose state with clinical and radiographic signs of aspiration pneumonia 16 hours following elective surgery. Subsequent clinical assessment and investigations revealed the characteristic facies, proximal muscle weakness, lenticular opacities, pulmonary function defects, arterial desaturation and abnormal breathing during rapid eye movement (REM) sleep often associated with myotonia dystrophica. Although these characteristic features were evident on clinical examination postoperatively they were not noted in the preoperative assessment. The aspiration pneumonia and coma were unusual presenting features of this disease. Unsuspected myotonia dystrophica should be considered in the differential diagnosis of unexplained respiratory depression, aspiration or comatose state following surgery. Recognition of the disorder during the preoperative assessment is the key to avoiding complications during the perioperative management of such patients.
Subject(s)
Coma/etiology , Myotonic Dystrophy/complications , Pneumonia, Aspiration/etiology , Adult , Anesthesia/methods , Female , HumansABSTRACT
The characteristics of induction with and recovery from isoflurane anaesthesia were studied in 248 children. The mean time to loss of consciousness was 1.5 min (SD 0.5). Tracheal intubation, without interruption of spontaneous ventilation, was accomplished in a mean time of 4.2 min (SD 54 seconds). Movement and excitement, of 20-30 seconds duration, occurred in 23.9% children and 22 patients coughed during induction; 15 (12.6%) during the first 124 inductions; 7 (5.6%) subsequently. The mean half-times of reduction of alveolar isoflurane concentrations in 28 children whose lungs were ventilated with isoflurane and in 13 children who breathed isoflurane spontaneously during anaesthesia were: 45 sec after exposure for one hour, 70 sec after exposure of 2-3 hours and 110 seconds following exposures of 4-8 hours. The mean recovery times of the three groups were 6.5, 9.5 and 11.5 min respectively. In two further groups of nine children the mean half times of elimination of halothane and isoflurane were 220 seconds and 54 seconds respectively; recovery from isoflurane was markedly faster. Isoflurane is well accepted by children; induction is more rapid than with halothane, and the marked flexibility in the control of its effects are due to its relative insolubility. It has wide application in paediatric anaesthesia.