ABSTRACT
PURPOSE: To assess and compare the frequency of reflex sneezing occurring during periocular anesthetic injections with and without intravenous sedation. DESIGN: Retrospective, comparative case series. METHODS: Seven hundred and twenty-two patients undergoing oculoplastic surgical procedures were included in this study. Those who received a periocular anesthetic injection under intravenous sedation served as the test group of 381 subjects. Those who received a periocular anesthetic injection without intravenous sedation served as the control group of 341 subjects. The absence or presence of reflex sneezing in both groups was recorded and compared using Chi-square analysis. RESULTS: Of the 381 patients who received periocular anesthetic injections under intravenous sedation, 19 (5%) exhibited a vigorous sneeze. Conversely, none of the 341 patients who received periocular anesthetic injections without intravenous sedation sneezed (P < or = .001). CONCLUSIONS: Surgeons, anesthesia staff, and other operating room personnel should be aware of this unusual and potentially dangerous sneeze phenomenon when periocular anesthetic injections are delivered under intravenous sedation to reduce potential ocular complications.
Subject(s)
Anesthetics, Intravenous/adverse effects , Anesthetics, Local/adverse effects , Conscious Sedation/adverse effects , Hypnotics and Sedatives/adverse effects , Propofol/adverse effects , Reflex/drug effects , Sneezing/drug effects , Adult , Aged , Aged, 80 and over , Anesthetics, Intravenous/administration & dosage , Anesthetics, Local/administration & dosage , Female , Humans , Hypnotics and Sedatives/administration & dosage , Injections , Lidocaine/administration & dosage , Lidocaine/adverse effects , Male , Middle Aged , Ophthalmologic Surgical Procedures , Propofol/administration & dosage , Retrospective StudiesABSTRACT
PURPOSE: To compare the outcomes achieved by a series of patients treated in a stepwise fashion who presented with congenital nasolacrimal duct obstruction. METHODS: In this retrospective interventional case series, 127 patients, ranging in age from 1 month to 81 months, with 173 lacrimal systems diagnosed with congenital nasolacrimal duct obstruction, were treated in a stepwise fashion. A treatment paradigm was evaluated that prescribed probing as an initial procedure regardless of age. Those who failed probing received balloon catheter dilation. Those who failed probing and balloon catheterization received silicone intubation. Dacryocystorhinostomy was reserved for patients failing the above treatments. Clinical success was defined as complete resolution of symptoms. Success rates at each step were evaluated, and a cost analysis was performed. RESULTS: Lacrimal probing was successful in 134 of 173 (76.9%) cases. Of the 39 probing failures, 32 (82.1%) were cured with balloon catheterization. All 7 cases (100%) that failed probing and balloon catheterization were cured with silicone intubation. No patient in this series required dacryocystorhinostomy. CONCLUSIONS: A stepwise approach to the treatment of congenital nasolacrimal duct obstruction is a clinically and financially effective model for treatment.