Safety of tropicamide and phenylephrine in pupillary mydriasis for cataract surgery.

PURPOSE: A prospective study to evaluate the adverse cardiovascular effects of topical phenylephrine and tropicamide used for pupillary mydriasis before cataract surgery. METHODS: A total of 517 consecutive eyes in 517 patients subjected to routine 0.8% tropicamide and 5% phenylephrine eye drops before undergoing cataract surgery (phacoemulsification and manual small-incision surgery) under local or topical anesthesia in a medical college hospital were analyzed. RESULTS: No untoward cardiovascular effects were seen. The increase in blood pressure after 0.8% tropicamide and 5% phenylephrine eye drops was statistically significant, but it was not relevant as it was within clinically permissible limits. CONCLUSION: The combination of 0.8% tropicamide and 5% phenylephrine eye drops is a safe and effective option for pupillary mydriasis before cataract surgery.

Sphenopalatine ganglion block: Intranasal transmucosal approach for anterior scalp blockade - A prospective randomized comparative study.

BACKGROUND AND AIMS: Peripheral nerve blocks in neurosurgical practice attenuate most stressful responses like pin insertion, skin, and dural incision. Scalp block is conventionally the blockade of choice. Further studies for less invasive techniques are required. Intranasal transmucosal block of the sphenopalatine ganglion has shown promising results in patients with chronic headache and facial pain. The primary objective of our study was to compare the gold standard scalp block and bilateral sphenopalatine ganglion block (nasal approach) for attenuation of hemodynamic response to pin insertion. Secondary objectives included hemodynamic response to skin and dural incision. MATERIAL AND METHODS: After IRB approval and informed consent, a prospective randomized comparative study was carried out on 50 adult patients undergoing elective supratentorial surgery. The hemodynamic response to pin insertion, skin incision, and dural incision was noted in both the groups. The data was analyzed with NCSS version 9.0 statistical software. RESULTS: The HR and MAP were comparable between the groups. Following dural incision MAP was significantly lower at 1,2,3,4,5 and 10 min in group SPG whereas in group S it was significantly lower at 1 and 2min. (P = 0.02 at T1, P = 0.03 at T2). CONCLUSIONS: Concomitant use of bilateral SPG block with general anesthesia is an effective and safe alternative technique to scalp blockade for obtundation of hemodynamic responses due to noxious stimulus during craniotomy surgeries.

Prolonged apnea with intramuscular ketamine: a case report.

We report a rare case of prolonged apnea following administration of ketamine. A healthy 11-month-old female child was administered intramuscular ketamine as a sole anesthetic agent for a short surgical procedure. Child developed respiratory depression and prolonged apnea requiring intubation and ventilation. She recovered completely after 90 min. This case report illustrates the potential hazard of ketamine, emphasizes the importance of being able to provide emergency airway management and monitored anesthesia care.