Opioid or Propofol: What Kind of Drug for What Kind of Sedation? Manual Dosing or Target-Controlled Infusion?

Contact topical anesthesia for strabismus surgery in adult patients

OBJECTIVE

To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients.

MATERIAL AND METHODS

A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed.

RESULTS

The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters.

CONCLUSIONS

Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment.

Optimizing intravenous drug administration by applying pharmacokinetic/pharmacodynamic concepts

This review discusses the ways in which anaesthetists can optimize anaesthetic-analgesic drug administration by utilizing pharmacokinetic and pharmacodynamic information. We therefore focus on the dose-response relationship and the interactions between i.v. hypnotics and opioids. For i.v. hypnotics and opioids, models that accurately predict the time course of drug disposition and effect can be applied. Various commercial or experimental drug effect measures have been developed and can be implemented to further fine-tune individual patient-drug titration. The development of advisory and closed-loop feedback systems, which combine and integrate all sources of pharmacological and effect monitoring, has taken the existing kinetic-based administration technology forwards closer to total coverage of the dose-response relationship.

Administration and monitoring of intravenous anesthetics

PURPOSE OF REVIEW

The importance of accuracy in controlling the dose-response relation for intravenous anesthetics is directly related to the importance of optimizing the efficacy and quality of anesthesia while minimizing adverse drug effects. Therefore, it is important to measure and control all steps of the pharmacokinetic and dynamic cascade influencing this dose-effect relationship.

RECENT FINDINGS

The ultimate goal when administering a particular dose of a drug is to obtain the desired clinical effect, taking into account interindividual pharmacokinetic and dynamic variability. Recent findings suggest that effect compartment-controlled target-controlled infusion systems and measurement of (surrogate) clinical drug effects might be helpful in an attempt to optimize the administration intravenous anesthetics and opioids. Additionally, recent findings suggest that the pharmacokinetic and dynamic interaction between anesthetics and opioids is important and such be taking into account when optimizing drug administration. Hereby, feedback control technology and advisory displays depicting these interactions have been studied.

SUMMARY

Anesthetic drug administration might be optimized by applying knowledge from clinical pharmacokinetics and dynamics.