Changes in refractive status of amblyopic patients with partially refractive esotropia

PURPOSE

To investigate the changes in refractive status of amblyopic patients with partially refractive esotropia (PAET).

MATERIALS AND METHODS

Amblyopic patients with PAET were enrolled. Non-amblyopic patients with full refractive accommodative esotropia (RAET) were included in the study as a control group. Preoperative and postoperative best-corrected visual acuity (BCVA), spherical equivalent (SE), astigmatism, stereoacuity, and deviations at near and distance were evaluated and statistically compared within the study group. Mean BCVA, SE, astigmatism were compared between the two groups.

RESULTS

The patient and the control groups were composed of 58 eyes of 29 patients per group. There were statistically significant differences between pre- and postoperative mean astigmatism and SE between the patient and control groups. The mean astigmatism was higher in amblyopic eyes when compared with the eyes in the control group (P:0.009). During the follow-up period, changes in SE and astigmatism were not different between groups.

CONCLUSION

The mean SE and astigmatism were changed in both amblyopic patients with PAET and non-amblyopic patients with RAET during the follow-up period. This suggested that neither amblyopia nor strabismus surgery has an effect on refractive status in patients with PAET.

The effect of different levels of pneumoperitoneum pressures on regional cerebral oxygenation during robotic assisted laparoscopic prostatectomy

Background/aim

This study aimed to evaluate the effect of low- and high-pressure pneumoperitoneum pressures applied during robotic-assisted laparoscopic prostatectomy (RALP) using near-infrared spectroscopy (NIRS) on regional cerebral oxygenation saturation (rSO₂).

Materials and methods

The prospective, comparative, and observational study included patients aged 18–80 years, with the American Society of Anesthesiologists (ASA) physical status I-II, who would undergo elective RALP. The patients were divided into two groups (12 mmHg of pneumoperitoneum pressure group, n=22 and 15 mmHg of pneumoperitoneum pressure group, n=23). Patients’ demographic data, durations of anesthesia, surgery, pneumoperitoneum, and Trendelenburg position, intraoperative estimated blood loss, fluid therapy, urine output, hemodynamic and respiratory data, and rSO₂ values were recorded at regular intervals.

Results

The rSO₂ values increased significantly during the pneumoperitoneum combined with steep Trendelenburg position (from t3 to t6 ) and at the end of the surgery ( t7 ) in both groups, compared to the values 5 min after the onset of pneumoperitoneum in the supine position ( t2 ) (P < 0.05), but no statistical significance was observed between the two groups. No cerebral desaturation was observed in any of our patients. Hemodynamic and respiratory parameters were preserved in both groups. The blood lactate levels were significantly higher in patients operated at high-pressure pneumoperitoneum, compared to those with low-pressure pneumoperitoneum (P < 0.05).

Conclusion

We believe that low-pressure pneumoperitoneum, especially in robotic surgeries, such as robotic-assisted laparoscopic prostatectomy (RALP), can be applied safely.

Evaluation of factors that affect skin to subarachnoid space distance

Introduction: Lumbar puncture is a procedure frequently used in anesthetic practice. For the success of the procedure, prediction of skin to subarachnoid space distance (SSD) is valuable. In this study, we aimed to evaluate the relationship between SSD with age and body mass index (BMI). Methods: Two hundred and fifty patients, ASA physical status I, II, and III scheduled to undergo elective surgery under spinal anesthesia, were studied. Spinal anesthesia was induced in the sitting position at the L3–4 vertebral level using a midline approach. Furthermore, the level of L3–L4 was identified by palpation, using Tuffier’s line as a guide. Following an intrathecal injection, the spinal needle was grasped between the thumb and the index finger during its removal from the patient’s back. From the grasping point, SSD was measured using rulers. Results: Mean values of SSD at the L3-4 interspace were 55.43±6.47 mm (range 35-74). Statistically significant correlations were observed between SSD with BMI and body weight (ρ=0.650, P<0.001 and ρ=0.651, P<0.001, respectively). Statistically significant correlation was not found between SSD with age, gender and body height (ρ=0.120, P=0.058; ρ=-0.047, P=0.4568 and ρ=0.089, P=0.159, respectively). Conclusions: SSD is affected by BMI and body weight but not by age, gender and body height.

Anaesthetic Management of Laparoscopic Morgagni Hernia Repair in a Patient with Coexisting Down Syndrome, Patent Foramen Ovale and Pectus Carinatum

Laparoscopic repair has several advantages with a minimally invasive surgical option for children with Morgagni hernias; however, a number of physiological sequelae results from pneumoperitoneum and insufflation. These physiological changes may be more significant in patients with a congenital heart disease. Perioperative detailed evaluation, meticulous monitorization and cooperation with a surgical team are important in cases with patent foramen ovale for the possible risk of the paradoxical gas embolism. We present the anaesthetic management of a patient with patent foramen ovale, Down syndrome and pectus carinatus who successfully underwent laparoscopic Morgagni hernia repair. Under a well-managed anaesthesia that prevented complications because of pneumoperitoneum, laparoscopic surgery would be safe enough for patients with Morgagni hernia having an associated congenital heart disease.

Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy

BACKGROUND

Anxiety is a common preprocedural problem and during processing especially in interventional medical processes.

AIM

Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy.

METHODS

Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected.

RESULTS

BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214).

CONCLUSIONS

We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status.

Simple handling of venous air embolism during abdominal myomectomy

We report a case of venous air embolism during abdominal myomectomy. Although true incidence of venous air embolism is not known, in literature most of reported cases are belongs to sitting position craniotomies. Many of those are subclinical, and diagnostic methods have varying degrees of sensitivity and specificity. At time of suspicion, prevention of any subsequent air emboli is the cornerstone of treatment.