Search Results (5)

Background/Objectives: Postoperative nausea and vomiting (PONV) are common after general anesthesia (GA) and, in patients undergoing vitreoretinal surgery, may be triggered by the oculocardiac reflex (OCR) leading to the oculoemetic reflex (OER). Inadequate dosing of intravenous rescue opioid analgesics may further provoke OCR. Adequacy of Anesthesia (AoA) monitoring enables optimized titration of intravenous rescue opioid analgesics, while preemptive intravenous or peribulbar analgesia may reduce opioid use. This study evaluated the impact of preemptive paracetamol or peribulbar block (PBB) combined with AoA-guided GA on the incidence of PONV, OCR, and OER in patients undergoing vitreoretinal surgery. Methods: A total of 185 patients were randomized to four groups: GA with AoA-guided intraoperative rescue opioid analgesia plus a single intravenous dose of paracetamol 1 g, or PBB using 1% ropivacaine, 0.5% bupivacaine, or a 1:1 mixture of 0.5% bupivacaine/2% lidocaine. Data from 175 patients were analyzed. Results: AoA-guided GA yielded an OCR incidence of 11.4% and PONV incidence of 4%. PBB, regardless of anesthetic solution, did not significantly reduce intraoperative rescue opioid analgesia requirements or the incidence of PONV, OCR, or OER compared with intravenous paracetamol. Notably, no PONV occurred in patients with three Apfel risk factors (predicted risk ≈ 61%) who received PBB. Conclusions: No overall advantage of PBB over intravenous paracetamol was observed. It may, however, benefit patients at high PONV risk. Full article

Background/Objectives: Some patients undergoing vitreoretinal surgery (VRS) require general anesthesia (GA), despite the possibility of developing intolerable postoperative pain perception (IPPP). Intraoperative rescue opioid analgesia (IROA) administration during GA poses a risk of perioperative nausea and vomiting (PONV), which may result in suprachoroidal hemorrhage with permanent visual impairment. Adequacy of Anesthesia (AoA) optimizes intraoperative IROA titration. Intravenous preemptive analgesia (IPA) with cyclooxygenase-3 (COX-3) inhibitors is added to GA to reduce the IROA dose. In this additional analysis, we assessed the impact of preemptive analgesia with COX-3 inhibitors, administered alongside GA with AoA-guided IROA, on the incidence of PONV, oculocardiac reflex (OCR), and oculoemetic reflex (OER) in patients undergoing VRS as secondary outcomes. Methods: A total of 165 patients scheduled for VRS were randomly assigned to receive AoA-guided GA combined with IPA at a single dose of 1 g of paracetamol (acetaminophen) or 2.5 g of metamizole or both. A total of nine patients were excluded due to technical problems with the intraoperative surgical pleth index (SPI) measurement, inability to report postoperative pain, and postoperative arousal resulting in a loss of follow-up in Stage 5. Results: Regardless of the group assignment, AoA guidance of GA resulted in PONV in 4%, OCR in 10%, and OER in 0% of the 153 analyzed patients undergoing VRS. No significant differences were observed between the groups regarding the type of IPA. PONV was observed in 2.11% (3/142) of patients with zero, one, or two risk factors of PONV, as compared to 27% (3/11) of patients with at least three PONV risk factors, assessed using the Apfel score. Conclusions: IPA with both paracetamol and metamizole did not demonstrate a benefit in reducing the analyzed adverse events compared with their single use in patients undergoing VRS under AoA guidance during GA. Surprisingly, PONV was hardly observed in patients with zero, one, or two PONV risk factors assessed by the Apfel score who underwent AoA-guided VRS during GA with IPA using one or two COX-3 inhibitors. Full article

Background/Objectives: The aim of this paper was to evaluate the safety of surgical intervention using anesthesia and ophthalmological parameters in pediatric strabismus patients. The design involved retrospective case series. Methods: The setting was the Department of Ophthalmology, Medical University Vienna, Austria. Participants: In total, 208 children aged 0–18 years who underwent strabismus surgery due to exotropia or esotropia between 2013 and 2020 were included. Main outcomes and measures: Information regarding the duration of surgery, intra- and postoperative complications, the postoperative angle of deviation (AoD), and functional outcomes (visual acuity, stereovision) were analyzed. Results: The mean age at the time of surgery was 6.0 ± 4.1 years (range 0.6–18.0). The mean anesthesia time among all patients was 75.9 ± 19.3 min. The mean surgery and anesthesia time did not differ between the age groups. Longer anesthesia durations and surgery durations did not have a significant effect on the occurrence of intraoperation complications (p = 0.610 and p = 0.190, respectively). Intraoperative complications were recorded in 53% (most frequent triggering of oculocardiac reflex (OCR)) of the patients, and postoperative complications in 22% (the most frequent were postoperative nausea and vomiting and pain). An OCR was triggered more often in children older than 6 years than in younger children (p = 0.016). The mean angle of deviation was significantly reduced from preoperative to postoperative measurements. Preoperative stereovision tests were positive in 35% of the patients and increased to over 80% postoperatively. Conclusions: Strabismus surgery performed under general anesthesia in children aged 0 to 18 years is safe with regard to both surgical and anesthetic complications. A significant decrease in the angle of deviation and high rate of stereovision could be achieved with a low rate of re-treatments. However, the retrospective design, absence of standardized documentation, and limited sample size may affect the consistency and comparability of this study’s findings. Full article

Vitreoretinal surgeries require the administration of general anesthesia (GA) in selected groups of patients. The administration of intraoperative rescue narcotic analgesia (IRNA) during GA poses the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI), a crucial component of the adequacy of anesthesia (AoA) guidance of GA, optimizes the intraoperative titration of IRNA. The current analysis evaluated the risk factors for the occurrence of PONV and the oculo-cardiac reflex (OCR) in patients undergoing pars plana vitrectomy (PPV) under AoA guidance. In total, 175 patients undergoing PPV were randomly allocated to receive either GA with SPI-guided IRNA administration using fentanyl alone or in addition to different preoperative analgesia techniques. Any incidence of PONV or OCR was recorded. Obesity, overweight, smoking status, motion sickness, postoperative intolerable pain perception, female gender, fluid challenge and arterial hypertension did not correlate with an increased incidence of PONV or OCR under AoA guidance. Diabetes mellitus, regardless of insulin dependence, was found to correlate with the increased incidence of PONV. The AoA regimen including SPI guidance of IRNA presumably created similar conditions for individual subjects, so no risk factors of the occurrence of PONV or OCR were found, except for diabetes mellitus. We recommend using AoA guidance for GA administration to reduce OCR and PONV rates. Full article

The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV. Full article