[Effects of sevoflurane versus propofol on oculocardiac reflex--a comparative study in 180 children]. / Die Auswirkungen von Sevofluran versus Propofol auf den okulokardialen Reflex--Eine vergleichende Untersuchung bei 180 Kindern.

Oculocardial reflex (OCR) occurs particularly through manipulation of the medial rectus muscle and results in a bradycardic arrhythmia. In children the incidence is between 60 and 80%. After using sevoflurane in clinical practice, the absence or non-occurrence of this reflex was observed. The data of 180 healthy children aged between four and 14 years who had to undergo strabismus surgery under general anaesthesia were analysed: group I (n = 92), group II (n = 88). All children received standard premedication with midazolam, no anticholinergic drugs were administered. During narcosis, analgesia was maintained routinely with alfentanil. In group I sevoflurane was inhaled for hypnosis and in group II propofol was injected as intravenous hypnotic drug. The depth of anaesthesia was adjusted according to clinical criteria. To compare both groups, heart rate (HR) was determined before, during and after surgical intervention. OCR was defined as a heart rate declining by more than 20% from the initial HR.OCR is described in all methods of general anaesthesia. Under sevoflurane the occurrence of the reflex was significantly (p < 0.05) reduced to 14% of all patients as compared to 75% in patients who received a propofol infusion. Sufficient reflex reduction according to the depth of narcosis under sevoflurane in combination with the sympathomimetic effects of this drug could therefore be discussed as a reason for its positive effects. In our opinion, the use of sevoflurane should be considered as an option for general anaesthesia in strabismus surgery.

[Ophthalmic surgery with local anesthesia or intubation anesthesia at the Leipzig University Ophthalmology Clinic]. / Ophthalmochirurgie in Lokalanästhesie oder Intubationsnarkose an der Augenklinik der Universität Leipzig.

BACKGROUND: Different opinions about the reliability and serious complications after regional anesthesia have been reported. The paper describes our experiences in deciding about regional or general anesthesia for ophthalmic surgery. PATIENTS AND METHODS: For this report we analyzed retrospectively our protocols of all operations performed in 1995. Eight categories of procedures were developed to give an insight in our way of decision for local or general anesthesia. We imagine the applied technique of peribulbaranesthesia. RESULTS: 3184 patients were operated on in 1995, in the regional anesthesia group the age ranges from 17 to 96 years, in the general anesthesia group from 3 months to 85 years. In 69.9% of all patients we performed a local anesthesia and in 30.1% we chose general anesthesia. The spread of cases and the surgical procedure corresponding to one of these eight classes below are described in this survey. CONCLUSIONS: Almost 70% of our patients who underwent an ophthalmosurgical procedure were operated on under regional anesthesia. No serious complications have occurred and no procedure had do be stopped off due to an insufficient analgesia or akinesia. We demonstrate some observations concerning the duration of pain after the injection and our indications for general anesthesia in ophthalmic surgery.

[Effect of diclofenac and flurbiprofen on the course of inflammation after cataract extraction]. / Zum Einfluss von Diclofenac und Flurbiprofen auf den Entzündungsverlauf nach der Kataraktextraktion.

In a prospective, randomized, double-blind study the effect of different anti-inflammatories (diclofenac 0.1%, flurbiprofen 0.03%) versus placebo on the intra- and postoperative inflammation in 65 eyes was examined. Prednisolone acetate 0.5% eye drops were the basic therapy in all three groups. As criteria served the difference between pre- and postoperative flare and cell concentration in the anterior chamber, measured using the laser flare cell meter, the clinical course, and the level of the inflammatory mediator 6-oxo-PGF1 alpha (prostacyclin) in the aqueous humor after intraoperative paracentesis, determined by means of enzyme-linked immunosorbent assay. The level of prostacyclin was not influenced in any of the three groups. The numbers of cells decreased continuously, but without marked differences among the groups. On the basis of the concentration of protein measured in the aqueous humor and the clinical course, diclofenac 0.1% proved to be a more potent additive anti-inflammatory therapy than flurbiprofen 0.03% immediately after the surgical procedure (P = 0.039 at 1 day after operation), but the final results (4 weeks after operation) revealed no detectable difference. By application of placebo, an obvious higher concentration of protein was measured during all the observations (P = 0.0002). Therefore in the case of cataract extraction the local steroidal therapy should be combined with nonsteroidal anti-inflammatory drugs (cyclooxygenase inhibitors).