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Rohowetz LJ, Panneerselvam S, Williams BK, Smiddy WE, Berrocal AM, Townsend JH, Gayer S, Palte HD, Flynn HW. Proliferative Sickle Cell Retinopathy: Outcomes of Vitreoretinal Surgery. Ophthalmol Retina 2024:S2468-6530(24)00049-6. [PMID: 38302055 DOI: 10.1016/j.oret.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To report the clinical presentation and outcomes in patients who underwent surgery for proliferative sickle cell retinopathy (PSCR). DESIGN Retrospective, consecutive case series. SUBJECTS All patients who underwent vitreoretinal surgery for complications secondary to PSCR between January 1, 2014, and December 31, 2021, at a university referral center. METHODS Retrospective consecutive case series. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), single operation anatomic success rate. RESULTS The study included 65 eyes of 61 patients. Disease distribution included 24 (44.4%) eyes with hemoglobin SC disease, 14 (25.9%) with hemoglobin SS disease, 13 (24.1%) with sickle cell trait, and 3 (5.6%) with sickle cell-β thalassemia. Preoperative transfusion was not performed in any study patients. Regional anesthesia with monitored anesthesia care (RA-MAC) was utilized in 58 (89.2%) eyes and general anesthesia in 7 (10.8%). In eyes that underwent surgery for retinal detachment (RD; N = 52) the rate of single operation anatomic success was 72.4% with combined scleral buckling/pars plana vitrectomy (SB/PPV; N = 29) compared with 47.8% with PPV alone (N = 23; P = 0.07). Mean BCVA at the last follow-up examination was 1.27 (20/372) in the SB/PPV group and 1.05 (20/226) in the PPV group (P = 0.48). In all SB cases, an encircling band was utilized and there were no known cases of anterior segment ischemia. All eyes that had surgery for vitreous hemorrhage (N = 13) underwent PPV with endolaser and mean BCVA improved from 1.67 (20/944) preoperatively to 0.45 (20/56) at last follow-up examination (P < 0.001). Mean preoperative BCVA, indication for surgery, single operation success rate, and mean BCVA at last follow-up examination did not differ based on sickle cell disease type (P > 0.05). CONCLUSIONS In patients with RD, SB/PPV achieved slightly higher rates of single operation anatomic success compared with PPV alone. Visual acuity outcomes were similar in the 2 groups. The majority of patients received RA-MAC anesthesia and preoperative transfusions were not performed. There were no cases of postoperative anterior segment ischemia. Hemoglobin SC disease was the most common disease type in the current study and surgical outcomes did not differ between sickle cell disease types. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Landon J Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Sugi Panneerselvam
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Basil K Williams
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Steven Gayer
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Howard D Palte
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
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Pai SL, Grech D, Gayer S, Rodriguez L, Joshi GP, Rajan N. Should rocuronium and sugammadex replace succinylcholine for airway emergencies in class B ambulatory anesthesia settings? Minerva Anestesiol 2023; 89:197-205. [PMID: 36326774 DOI: 10.23736/s0375-9393.22.16852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION In class B surgical facilities, where only oral or intravenous (IV) sedation is employed without the administration of volatile anesthetics, laryngospasm is among the most common airway complications. However, these facilities generally do not stock succinylcholine to avoid the cost of storing dantrolene for the treatment of malignant hyperthermia (MH). High dose IV rocuronium with sugammadex reversal has been suggested as an alternative to succinylcholine for airway emergencies. The aim of this paper was to evaluate the clinical utility, patient safety, and financial implications of replacing succinylcholine with rocuronium and sugammadex in lieu of stocking dantrolene in class B facilities. EVIDENCE ACQUISITION A systematic review of the literature concerning neuromuscular blockade for airway emergencies in class B settings in adult patients was conducted. The MEDLINE and EMBASE databases were searched for published studies from January 1, 1990, to October 1, 2021. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence. EVIDENCE SYNTHESIS The search strategy yielded 1124 articles. After review, 107 articles were included, with 49 graded as "strong" evidence to provide recommendations for the posed questions. CONCLUSIONS The use of succinylcholine in isolation without volatile agents has a low incidence of triggering MH. Laryngospasm is a common airway emergency that requires immediate treatment to avoid morbidity and mortality. Both succinylcholine and rocuronium-sugammadex provide adequate treatment of airway emergencies and rapid return of spontaneous ventilation, but succinylcholine has a superior economic and clinical profile.
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Affiliation(s)
- Sher-Lu Pai
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA -
| | - Dennis Grech
- New Jersey Medical School, Department of Anesthesiology, Rutgers, Newark, NJ, USA
| | - Steven Gayer
- Miller School of Medicine, Department of Anesthesiology, University of Miami, Miami, FL, USA
| | - Leopoldo Rodriguez
- Anesthesiology and Perioperative Medicine, Boulder Valley Anesthesiology PLLC, Boulder, CO, USA
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, UT Southwestern Medical Center, Dallas, TX, USA
| | - Niraja Rajan
- Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, PA, USA
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Levine H, Naranjo A, Martinez JD, Altamirano DS, Gayer S, O’Brien TP, Karp CL, Amescua G. Considerations for Corneal Surgery With Patients in the 10th Decade of Life. Cornea 2022; 41:1222-1231. [PMID: 34743105 PMCID: PMC9065212 DOI: 10.1097/ico.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to report the indications, ocular and systemic comorbidities, and surgical outcomes of corneal transplantation in patients older than 90 years. METHODS A retrospective review was conducted to identify individuals 90 years and older who underwent corneal transplantation surgery at the Bascom Palmer Eye Institute between January 2013 and October 2020. Outcomes included best-corrected visual acuity and graft survival over time. Paired t tests were used to compare visual acuity preoperatively versus postoperatively. Graft survival was evaluated with Kaplan-Meier curves. RESULTS Fifty-eight eyes of 52 consecutive individuals were included. The mean age of individuals was 92 ± 2 years; 26.9% were male; and 48.1% self-identified as non-Hispanic White and 38.5% as Hispanic. Postoperative follow-up was 14.7 ± 12.1 months. Of the 58 eyes, 44.8% (26/58) underwent penetrating keratoplasty, 46.6% (27/58) Descemet stripping automated endothelial keratoplasty, and 6.9% (4/58) keratoprosthesis. All surgeries were performed under monitored local anesthesia, without major complications. Surgical indications included pseudophakic bullous keratopathy (36.2%), glaucoma-associated corneal decompensation (27.6%), Fuchs endothelial dystrophy (25.9%), and perforated corneal ulceration (19.0%). The best-corrected visual acuity improved by 0.32 (95% confidence interval 0.14-0.50; P < 0.01) as early as 1 month postoperatively, and vision gains were sustained for at least 12 months. Graft survival probability at 12 months was 88%. CONCLUSIONS Corneal transplantation is a safe and successful procedure in restoring the visual acuity for patients older than 90 years after careful preoperative evaluation. Further research is needed to evaluate the impact of corneal transplantation on quality of life in patients in the 10th decade of life.
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Affiliation(s)
- Harry Levine
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrea Naranjo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jaime D. Martinez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diego S. Altamirano
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven Gayer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Anesthesia, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Terrence P. O’Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carol L. Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Guillermo Amescua
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Sweitzer B, Rajan N, Schell D, Gayer S, Eckert S, Joshi GP. Preoperative Care for Cataract Surgery: The Society for Ambulatory Anesthesia Position Statement. Anesth Analg 2021; 133:1431-1436. [PMID: 34784329 DOI: 10.1213/ane.0000000000005652] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cataract surgeries are among the most common procedures requiring anesthesia care. Cataracts are a common cause of blindness. Surgery remains the only effective treatment of cataracts. Patients are often elderly with comorbidities. Most cataracts can be treated using topical or regional anesthesia with minimum or no sedation. There is minimal risk of adverse outcomes. There is general consensus that cataract surgery is extremely low risk, and the benefits of sight restoration and preservation are enormous. We present the Society for Ambulatory Anesthesia (SAMBA) position statement for preoperative care for cataract surgery.
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Affiliation(s)
- BobbieJean Sweitzer
- From the Departments of Anesthesiology and Surgical Services, Inova Health System, Falls Church, Virginia
| | - Niraja Rajan
- Hershey Outpatient Surgery Center, Department of Anesthesiology and Perioperative Medicine, Penn State Health, Hershey, Pennsylvania
| | - Dawn Schell
- Cole Eye and Anesthesiology Institutes, Cleveland Clinic, Cleveland, Ohio, Cleveland, Ohio
| | - Steven Gayer
- Department of Anesthesiology, University of Miami's Miller School of Medicine, Miami, Florida
| | - Stan Eckert
- Regional Medical Director Ambulatory Surgery Division, Hospital Corporation of America, Austin, Texas
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Iyer PG, Gayer S, Albini TA, Flynn HW. Venous Air Embolus: A Rare but Serious Complication of Fluid-Gas Exchange During Pars Plana Vitrectomy. Am J Ophthalmol 2021; 227:S0002-9394(21)00131-8. [PMID: 33773980 DOI: 10.1016/j.ajo.2021.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Prashanth G Iyer
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven Gayer
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Thomas A Albini
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Harry W Flynn
- From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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6
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Affiliation(s)
- Howard Palte
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steven Gayer
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA
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Lam BL, Mendoza-Santiestaban C, Gonzalez A, Rowaan C, Liu M, Martin J, Gayer S, Figueredo OG, Parel JM. Electroretinogram Recording for Infants and Children under Anesthesia to Achieve Optimal Dark Adaptation and International Standards. J Vis Exp 2020. [PMID: 32955497 DOI: 10.3791/61734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Electroretinogram (ERG) is the only clinical objective test available to assess retinal function. Full-field ERG (ffERG) measures the panretinal rod and cone photoreceptor function as well as inner retinal function and is an important measure in the diagnosis and management of inherited retinal diseases as well as inflammatory, toxic, and nutritional retinopathies. Adhering to international standards and maintaining retinal dark adaptation are critical to acquire valid and reliable dark-adapted (scotopic) and light-adapted (photopic) ffERG responses. Performing ffERG in infants and children is challenging and often requires general anesthesia in the operating room. However, maintaining retinal dark adaptation in the operating room is becoming increasingly difficult given the numerous light sources from anesthesiology monitoring systems and other equipment. A practical and widely applicable method for ffERG testing is described in the operating room that optimizes retinal dark adaptation. The method reduces operating room time by dark-adapting the patient before general anesthesiology is instituted. The operating room is modified for dark adaptation and any remaining light source in the darkened operating room is minimized with the use of a modified portable foldable darkroom that encloses the patient's head and the ERG examiner during ffERG scotopic recordings. The simple method adheres to ffERG international standards and provides valid reliable scotopic and photopic ffERG recordings that are critical to assess objective retinal function in this young age group where subjective assessment of visual function such as visual acuity and visual fields are not possible. Furthermore, the ffERG is the gold standard clinical test in detecting early onset inherited retinal diseases including Leber congenital amaurosis where approved gene therapy has become available. In sedated conditions, very low amplitude ffERG signals can be detected due to minimal orbicularis muscle activity interference, which is particularly relevant in patients after gene therapy to detect improved amplitude responses.
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Affiliation(s)
- Byron L Lam
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine;
| | | | - Alex Gonzalez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Cornelis Rowaan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Mu Liu
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Joanne Martin
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Steven Gayer
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine; Department of Anesthesiology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Osmany Gil Figueredo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - Jean-Marie Parel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
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Abstract
Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction anesthesia in pediatric ophthalmic surgery. Key anatomic differences in axial length, intraocular pressure, and available orbital space between young children and adults impact conduct of ophthalmic regional anesthesia. The eye is near adult size at birth and completes its growth rapidly while the orbit does not. This results in significantly diminished extraocular orbital volumes for local anesthetic deposition. Needle-based blocks are categorized by relation of the needle to the extraocular muscle cone (ie, intraconal or extraconal) and in the cannula-based block, by description of the potential space deep to the Tenon capsule. In children, blocks are placed after induction of anesthesia by a pediatric anesthesiologist or ophthalmologist, via anatomic landmarks or under ultrasonography. Ocular conduction anesthesia confers several advantages for eye surgery including analgesia, akinesia, ablation of the oculocardiac reflex, and reduction of postoperative nausea and vomiting. Short (16 mm), blunt-tip needles are preferred because of altered globe-to-orbit ratios in children. Soft-tip cannulae of varying length have been demonstrated as safe in sub-Tenon blockade. Ultrasound technology facilitates direct, real-time visualization of needle position and local anesthetic spread and reduces inadvertent intraconal needle placement. The developing eye is vulnerable to thermal and mechanical insults, so ocular-rated transducers are mandated. The adjuvant hyaluronidase improves ocular akinesia, decreases local anesthetic dosage requirements, and improves initial block success; meanwhile, dexmedetomidine increases local anesthetic potency and prolongs duration of analgesia without an increase in adverse events. Intraconal blockade is a relative contraindication in neonates and infants, retinoblastoma surgery, and in the presence of posterior staphylomas and buphthalmos. Specific considerations include pertinent pediatric ophthalmologic topics, block placement in the syndromic child, and potential adverse effects associated with each technique. Recommendations based on our experience at a busy academic ophthalmologic tertiary referral center are provided.
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Affiliation(s)
- Yuel-Kai Jean
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - David Kam
- From the Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Steven Gayer
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Howard D Palte
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida
| | - Alecia L S Stein
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida
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Urman RD, Rajan N, Belani K, Gayer S, Joshi GP. Malignant Hyperthermia-Susceptible Adult Patient and Ambulatory Surgery Center: Society for Ambulatory Anesthesia and Ambulatory Surgical Care Committee of the American Society of Anesthesiologists Position Statement. Anesth Analg 2020; 129:347-349. [PMID: 31166228 DOI: 10.1213/ane.0000000000004257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This document represents a joint effort of the Society for Ambulatory Anesthesia (SAMBA) and the Ambulatory Surgical Care Committee of the American Society of Anesthesiologists (ASA) concerning the safe anesthetic care of adult malignant hyperthermia (MH)-susceptible patients in a free-standing ambulatory surgery center (ASC). Adult MH-susceptible patients can safely undergo a procedure in a free-standing ASC assuming that proper precautions for preventing, identifying, and managing MH are taken. The administration of preoperative prophylaxis with dantrolene is not indicated in MH-susceptible patients scheduled for elective surgery. There is no evidence to recommend an extended stay in the ASC, and the patient may be discharged when the usual discharge criteria for outpatient surgery are met. Survival from an MH crisis in an ASC setting requires early recognition, prompt treatment, and timely transfer to a center with critical care capabilities.
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Affiliation(s)
- Richard D Urman
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Niraja Rajan
- Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center/Penn State Health, Hershey, Pennsylvania
| | - Kumar Belani
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
| | - Steven Gayer
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Health System, Miami, Florida
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas
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Yannuzzi NA, Sridhar J, Flynn HW, Gayer S, Berrocal AM, Patel NA, Townsend J, Smiddy WE, Albini T. Current Trends in Vitreoretinal Anesthesia. Ophthalmol Retina 2019; 3:804-805. [PMID: 31307941 DOI: 10.1016/j.oret.2019.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/21/2019] [Accepted: 05/23/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Steven Gayer
- Department of Anesthesiology, University of Miami, Miller School of Medicine, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Nimesh A Patel
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Justin Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida
| | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
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11
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Affiliation(s)
- Howard D Palte
- Department Anesthesiology, University of Miami, Miller School of Medicine, Miami, Florida,
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12
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13
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Palte HD, Gayer S. Novel technique for minimally invasive sub-Tenon's anesthesia. Reg Anesth Pain Med 2019; 44:131-132. [PMID: 30640665 DOI: 10.1136/rapm-2018-000025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/02/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Howard D Palte
- Department of Anesthesiology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Steven Gayer
- Department of Anesthesiology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Gayer S, Prielipp RC. The Eye: What You Don't Know Can Hurt Your Patient. Anesth Analg 2018; 126:1446-1447. [PMID: 29672383 DOI: 10.1213/ane.0000000000002846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Steven Gayer
- From the Department of Anesthesiology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Richard C Prielipp
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota
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McClellan AJ, Daubert JJ, Relhan N, Tran KD, Flynn HW, Gayer S. Comparison of Regional vs. General Anesthesia for Surgical Repair of Open-Globe Injuries at a University Referral Center. Ophthalmol Retina 2017; 1:188-191. [PMID: 28944317 DOI: 10.1016/j.oret.2016.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This study compares the clinical features and physician selection of either Regional Anesthesia (peribulbar or retrobulbar block) with Monitored Anesthesia Care (RA-MAC) or General Anesthesia (GA) for open globe injury repair. DESIGN A non-randomized, comparative, retrospective case series at a University Referral Center. PARTICIPANTS All adult repairable open globe injuries receiving primary repair between January 1st, 2004 and December 31st, 2014 (11 years). Exclusion criteria were patients less than 18 years of age and those treated with primary enucleation. METHODS Data was gathered via retrospective chart review. MAIN OUTCOME MEASURES Data collected from each patient was age, gender, injury type, location, length of wound, presenting visual acuity, classification of anesthesia used, duration of the procedure performed, months of clinical follow-up, and final visual acuity. RESULTS During the 11 years study period, 448 patients were identified who had open globe injuries with documented information on zone of injury. Globe injury repair was performed using RA-MAC in 351/448 (78%) patients and general anesthesia in 97/448 (22%) patients. Zone 1, 2 and 3 injuries were recorded in 241, 135, and 72 patients respectively. The rates in specific zones, of RA-MAC versus GA were as follows: Zone 1 - 213/241 (88%) vs 28/241 (12%), Zone 2 - 104/135 (77%) vs 31/135 (23%) and Zone 3 - 34/72 (47%) vs 38/72 (53%). Open globe injuries repaired under RA-MAC had significantly shorter wound length (p<0.001), more anterior wound location (p<0.001) and shorter operative times (p<0.001). RA-MAC cases also had a better presenting and final visual acuity (p<0.001). Neither class of anesthesia conferred a greater visual acuity improvement (p=0.06). The use of GA did not cause any delay in the time elapsed from injury until surgical repair (p=0.74). CONCLUSIONS RA-MAC is a reasonable alternative to GA for the repair of open globe injuries in selected adult patients. RA-MAC was selected more often for Zone 1 and Zone 2 injuries. For eyes with Zone 3 injuries, there are equal selection ratio for RA-MAC and GA.
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Affiliation(s)
- Andrew J McClellan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Jacquelyn J Daubert
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Kimberly D Tran
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, 900 NW 17th Street, Miami, Florida, USA 33133
| | - Steven Gayer
- Department of Anesthesiology, University of Miami, Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136
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Kasi SK, Grant S, Flynn HW, Albini TA, Relhan N, Heier JS, Gayer S, Garg SJ. Venous Air Embolism During Pars Plana Vitrectomy: A Case Report and Review of the Literature. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2474126417718097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose: Presumed venous air embolism (PVAE) is a rare and potentially fatal complication of pars plana vitrectomy that is poorly described and understood but requires improved awareness among ophthalmologists and vitreoretinal surgeons. Methods: A case report is presented along with a systematic review of published reports of PVAE during ocular surgery. Results: An otherwise healthy adult male undergoing retinal detachment repair under local anesthesia with monitored anesthesia care died from a PVAE. Literature search yielded 2 experimental models, 6 individual case reports, and several editorials. Review of existing reports reveals that PVAE can affect patients of any age or gender with no medical predilection and occurs in cases of trauma, endoresection, or retinal detachment repair. It is typically associated with a drop in end-tidal carbon dioxide during fluid–air exchange and can present similar to a hemorrhagic choroidal detachment. Analysis suggests that venous air embolism can be prevented by ensuring full engagement of the infusion cannula into the vitreous cavity prior to fluid–air exchange. Conclusion: Presumed venous air embolism is a potentially fatal complication of ocular surgery and in some cases may be recognized by ophthalmologists as a choroidal detachment during fluid–air exchange in pars plana vitrectomy. It is imperative to immediately stop the air infusion line if venous air embolism is suspected.
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Affiliation(s)
- Sundeep K. Kasi
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott Grant
- Retina Consultants of Orange County, Fullerton, CA, USA
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Thomas A. Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Nidhi Relhan
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Jeffrey S. Heier
- Ophthalmic Consultants of Boston and Tufts University School of Medicine, Boston, MA, USA
| | - Steven Gayer
- Department of Anesthesiology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL, USA
| | - Sunir J. Garg
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, and Thomas Jefferson University, Philadelphia, PA, USA
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Gayer S, Gedde SJ. Intraoperative Management of Increased Intraocular Pressure in a Patient with Glaucoma Undergoing Robotic Prostatectomy in Trendelenburg Position. ACTA ACUST UNITED AC 2016; 6:17-8. [DOI: 10.1213/xaa.0000000000000233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gayer S, Tran T. Ophthalmic Anesthesia Society 2014 Annual Scientific Meeting Summary. Anesth Analg 2015. [DOI: 10.1213/ane.0000000000000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Palte HD, Cavuoto KM, Sundararaman L, Gayer S, Schiffman J, Capo H. The quest for effective pain control during suture adjustment after strabismus surgery: a study evaluating supplementation of 2% lidocaine with 0.4% ropivacaine. J Pain Res 2015; 8:33-7. [PMID: 25609996 PMCID: PMC4298306 DOI: 10.2147/jpr.s74587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures. Methods Prospective, double-blind study of 30 adult patients aged 21–84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points. Results The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7). Conclusion We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery.
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Affiliation(s)
| | | | | | | | | | - Hilda Capo
- Bascom Palmer Eye Institute, Miami, FL, USA
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Bayes J, Gayer S. Ophthalmic Anesthesia Society 2013 Annual Meeting Summary. Anesth Analg 2014. [DOI: 10.1213/ane.0000000000000132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Affiliation(s)
- Howard D Palte
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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Varga EQS, Candiotti KA, Saltzman B, Gayer S, Giquel J, Castillo-Pedraza C, Sanchez G, Halliday N. Evaluation of distal radial artery cross-sectional internal diameter in pediatric patients using ultrasound. Paediatr Anaesth 2013; 23:460-2. [PMID: 23577822 DOI: 10.1111/pan.12151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2013] [Indexed: 11/30/2022]
Abstract
In this study, we measure the radial artery internal diameter (RAID) in children up to 4 years of age before and after the induction of anesthesia. A B-mode portable color Doppler ultrasound was used to measure the RAID. Three sets of measurements were taken for each child before and after the induction of anesthesia and with the wrist in the neutral and dorsiflexed positions. The reliability of the mean value of the RAID in the three sets in 24 patients was established. There were discrepancies between the RAID and the proposed catheter size in some individuals, which may not only render placement difficult but also have potential for arterial injury. There are good reasons to measure the RAID in small children prior to insertion of an intra-arterial catheter.
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Affiliation(s)
- Eliane Q S Varga
- Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, FL 33136, USA.
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Palte HD, Gayer S, Arrieta E, Scot Shaw E, Nose I, Lee E, Arheart KL, Dubovy S, Birnbach DJ, Parel JM. Are ultrasound-guided ophthalmic blocks injurious to the eye? A comparative rabbit model study of two ultrasound devices evaluating intraorbital thermal and structural changes. Anesth Analg 2012; 115:194-201. [PMID: 22504211 PMCID: PMC3381790 DOI: 10.1213/ane.0b013e318253622e] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Since Atkinson's original description of retrobulbar block in 1936, needle-based anesthetic techniques have become integral to ophthalmic anesthesia. These techniques are unfortunately associated with rare, grave complications such as globe perforation. Ultrasound has gained widespread acceptance for peripheral nerve blockade, but its translation to ocular anesthesia has been hampered because sonic energy, in the guise of thermal or biomechanical insult, is potentially injurious to vulnerable eye tissue. The US Food and Drug Administration (FDA) has defined guidelines for safe use of ultrasound for ophthalmic examination, but most ultrasound devices used by anesthesiologists are not FDA-approved for ocular application because they generate excessive energy. Regulating agencies state that ultrasound examinations can be safely undertaken as long as tissue temperatures do not increase >1.5°C above physiological levels. METHODS Using a rabbit model, we investigated the thermal and mechanical ocular effects after prolonged ultrasonic exposure to single orbital- and nonorbital-rated devices. In a dual-phase study, aimed at detecting ocular injury, the eyes of 8 rabbits were exposed to continuous 10-minute ultrasound examinations from 2 devices: (1) the Sonosite Micromaxx (nonorbital rated) and (2) the Sonomed VuMax (orbital rated) machines. In phase I, temperatures were continuously monitored via thermocouples implanted within specific eye structures (n = 4). In phase II the eyes were subjected to ultrasonic exposure without surgical intervention (n = 4). All eyes underwent light microscopy examinations, followed at different intervals by histology evaluations conducted by an ophthalmic pathologist. RESULTS Temperature changes were monitored in the eyes of 4 rabbits. The nonorbital-rated transducer produced increases in ocular tissue temperature that surpassed the safe limit (increases >1.5°C) in the lens of 3 rabbits (at 5.0, 5.5, and 1.5 minutes) and cornea of 2 rabbits (both at 1.5 minutes). A secondary analysis of temporal temperature differences between the orbital-rated and nonorbital transducers revealed statistically significant differences (Bonferroni-adjusted P < 0.05) in the cornea at 3.5 minutes, the lens at 2.5 minutes, and the vitreous at 4.0 minutes. Light microscopy and histology failed to elicit ocular injury in either group. CONCLUSIONS The nonorbital-rated ultrasound machine (Sonosite Micromaxx) increases the ocular tissue temperature. A larger study is needed to establish safety. Until then, ophthalmic ultrasound-guided blocks should only be performed with ocular-rated devices.
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Affiliation(s)
- Howard D Palte
- Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, 900 NW 17th Street, Miami FL 33136, USA.
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Palte HD, Gayer S. External ocular compression devices in glaucoma. Anaesthesia 2011; 66:750. [PMID: 21749352 DOI: 10.1111/j.1365-2044.2011.06799.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wykoff CC, Murray TG, Markoe AM, Feun LG, Schefler AC, Gayer S. Preoperative evaluation for patients with choroidal/ciliary body melanomas: what is necessary? Am J Ophthalmol 2011; 151:921-4. [PMID: 21616209 DOI: 10.1016/j.ajo.2011.01.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 11/17/2022]
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Vigoda MM, Latiff A, Murray TG, Tutiven JL, Berrocal AM, Gayer S. Can children undergoing ophthalmologic examinations under anesthesia be safely anesthetized without using an IV line? Clin Ophthalmol 2011; 5:503-8. [PMID: 21573039 PMCID: PMC3090306 DOI: 10.2147/opth.s18605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Indexed: 11/29/2022] Open
Abstract
Purpose: To document that with proper patient and procedure selection, children undergoing general inhalational anesthesia for ophthalmologic exams (with or without photos, ultrasound, laser treatment, peri-ocular injection of chemotherapy, suture removal, and/or replacement of ocular prosthesis) can be safely anesthetized without the use of an intravenous (IV) line. Children are rarely anesthetized without IV access placement. We performed a retrospective study to determine our incidence of IV access placement during examinations under anesthesia (EUA) and the incidence of adverse events that required intraoperative IV access placement. Methods: Data collected from our operating room (OR) information system includes but is not limited to diagnosis, anesthesiologist, surgeon, and location of IV catheter (if applicable), patient’s date of birth, actual procedure, and anesthesia/procedure times. We reviewed the OR and anesthetic records of children (>1 month and <10 years) who underwent EUAs between January 1, 2003 and May 31, 2009. We determined the percentage of children who were anesthetized without IV access placement, as well as the incidence of any adverse events that required IV access placement, intraoperatively. Results: We analyzed data from 3196 procedures performed during a 77-month period. Patients’ ages ranged from 1 month to 9 years. Overall, 92% of procedures were performed without IV access placement. Procedure duration ranged from 1–39 minutes. Reasons for IV access placement included parental preference for antinausea medication and/or attending preference for IV access placement. No child who underwent anesthesia without an IV line had an intraoperative adverse event requiring insertion of an IV line. Conclusion: Our data suggest that for children undergoing general anesthesia for ophthalmologic exams (with or without photos, ultrasound, laser treatment, intraocular injection of chemotherapy, suture removal, and/or replacement of ocular prosthesis), anesthesia can be safely conducted without placement of an IV line.
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Affiliation(s)
- Michael M Vigoda
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Gayer S, Palte H, Kumar C, Luyet C, Eichenberger U, Tappeiner C, Greif R. Real-time visualization of ultrasound-guided retrobulbar blockade: an imaging study. Br J Anaesth 2009; 102:561-2; author reply 562. [DOI: 10.1093/bja/aep028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vigoda MM, Gayer S, Tutiven J, Mueller A, Murtha M, Schefler AC, Murray TG. Targeting operating room inefficiencies in the complex management of vision-threatening diseases in children. ACTA ACUST UNITED AC 2008; 126:1241-3. [PMID: 18779484 DOI: 10.1001/archopht.126.9.1241] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To review the effect of interventions designed to decrease turnover time in infants and children (median age, 2.6 years; range, 1 month to 10 years) who required examinations under anesthesia. METHODS Five efficiency interventions (3 anesthesia providers for 2 rooms, digital remote communication, change in patient scheduling, standardization of case order, and streamlining administration of preoperative medications) were implemented during a 4(1/2)-year period from January 2003 to July 2007. Using data from our in-house operating room information system, we analyzed turnover times (time it took 1 patient to leave the operating room and the next to enter). RESULTS The mean turnover times decreased from 12.1 minutes to 3.8 minutes. The 90th percentile of longest turnover times decreased from 14.5 minutes in 2003 to 5.8 minutes in 2007, despite a progressive increase in the number of cases per day. CONCLUSION Caring for children who require extensive examinations under anesthesia can be efficiently achieved in nonpediatric environments.
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Affiliation(s)
- Michael M Vigoda
- Department of Anesthesiology, Preoperative Medicine, and Pain Management, University of Miami/Jackson Memorial Hospital, 1611 NW 12th Ave, Room C-301, Miami, FL 33136, USA.
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Smiddy WE, Gayer S. Preemptive sub-tenon's anesthesia for pars plana vitrectomy under general anesthesia: is it effective? Ophthalmic Surg Lasers Imaging 2008; 39:438-439. [PMID: 18831435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Smiddy WE, Gayer S, Mason JO, Goodwin PL, Feist RM, Vail RS. Preemptive Sub-Tenon’s Anesthesia for Pars Plana Vitrectomy Under General Anesthesia: Is It Effective? Ophthalmic Surg Lasers Imaging Retina 2008. [DOI: 10.3928/15428877-20080901-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gayer S, Kumar CM. Ophthalmic regional anesthesia techniques. Minerva Anestesiol 2008; 74:23-33. [PMID: 17380099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
There is substantial national and international variation in the conduct of anesthesia for ophthalmic surgical procedures. Ophthalmic regional anesthetic techniques include traditional needle-based blocks, such as intraconal or extraconal injections; sub-Tenon's blocks which can be accomplished with needles, but are more commonly performed with blunt cannulae; and topical anesthesia. Needle-based techniques are generally safe although rare, serious sight- and life-threatening complications may occur. In recent years, a renewed interest in sub-Tenon's and topical anesthesia has emerged. Currently there is no absolutely safe ophthalmic regional block. It is essential that those who are involved in the care of ophthalmic patients have a thorough knowledge of the approaches employed and their associated risks and benefits. This review article outlines the relevant anatomy, commonly used techniques and their safe performance.
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Affiliation(s)
- S Gayer
- Department of Anesthesiology, and Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
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Charles S, Rosenfeld PJ, Gayer S. Medical Consequences of Stopping Anticoagulant Therapy Before Intraocular Surgery or Intravitreal Injections. Retina 2007; 27:813-5. [PMID: 17891002 DOI: 10.1097/iae.0b013e318154b9f2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Cass GD, Gayer S. Comparing anesthetic techniques during ocular surgery in humans and dogs. J Am Vet Med Assoc 2006; 229:1372; author reply 1372-3. [PMID: 17143997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Gayer S, Denham D, Alarakhia K, Bernal A, Cardenas G, Duncan R, Parel JM. Ocular decompression devices: liquid mercury balloon vs the tungsten powder balloon. Am J Ophthalmol 2006; 142:500-1. [PMID: 16935602 DOI: 10.1016/j.ajo.2006.03.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2006] [Revised: 03/17/2006] [Accepted: 03/19/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine if an intraocular pressure (IOP)-reducing device containing tungsten powder decreases pressure comparably to the traditional mercury-containing apparatus. DESIGN Prospective randomized, single-blind, controlled, phase I equivalence study. METHOD At a tertiary care center, both eyes of 24 volunteers with normal IOP were treated with an ocular compression device containing either liquid mercury or tungsten powder. The IOP was measured at baseline and after 10 minutes of ocular compression. RESULTS The mean reduction in IOP was 3.6 mm Hg +/- 2.0 with the mercury-containing device and 4.4 mm Hg +/- 2.1 with the tungsten-filled apparatus. An equivalence study analysis using a paired t-test and a sequential analysis protocol did not demonstrate a statistically significant difference between the IOP-lowering effects of the two devices. CONCLUSIONS The IOP-lowering effect produced by a tungsten powder-filled balloon ocular decompression device compared with a traditional mercury-containing device was not statistically different.
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Affiliation(s)
- Steven Gayer
- ABLEH, Bascom Palmer Eye Institute, Miami, FL 33136, USA.
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Abstract
Ophthalmic pathology in infants and children undergoing eye surgery ranges from the rare and atypical to the commonplace. These pathologies include nasolacrimal duct obstruction, strabismus, congenital or traumatically induced cataracts, penetrating eye injuries, glaucoma, retinopathy of prematurity, intraorbital tumors, and more. Nasolacrimal duct stenosis, cataracts, and traumatic eye injuries often occur in otherwise healthy pediatric patients; however, many ophthalmopathies can be associated with other congenital disorders that may have important anesthesia implications. In this article, we will review pertinent anesthesia issues within the context of various ophthalmic diseases.
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Affiliation(s)
- Steven Gayer
- University of Miami Miller School of Medicine, 900 Northwest 17th Street, Miami, FL 33136, USA.
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Scott IU, Gayer S, Voo I, Flynn HW, Diniz JR, Venkatraman A. Regional anesthesia with monitored anesthesia care for surgical repair of selected open globe injuries. Ophthalmic Surg Lasers Imaging 2005; 36:122-8. [PMID: 15792313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVE To investigate clinical features and visual acuity outcomes associated with the use of regional anesthesia with monitored anesthesia care (RA/MAC) versus general anesthesia for open globe injuries in adult reparable eyes. PATIENTS AND METHODS Retrospective, consecutive case series including all adults with open globe injuries repaired at Bascom Palmer Eye Institute between 2000 and 2003. RESULTS The study included 238 eyes of 238 patients with a median age of 41 years. RA/MAC was employed in 141 (59%) eyes and general anesthesia in 97 (41%) eyes. Patients who had RA/MAC were significantly (P< .001) more likely to have anterior wound location (64% corneal/limbal vs 50%), shorter wound length (6.5 vs 12 mm), and formed anterior chamber (82% vs 56%), and were significantly less likely to have an afferent pupillary defect (12% vs 43%). The improvement from presenting visual acuity to each postoperative follow-up interval was similar for the two groups. CONCLUSIONS RA/MAC is a reasonable alternative to general anesthesia for selected patients with open globe injuries.
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Affiliation(s)
- Ingrid U Scott
- Departments of Ophthalmology and Anesthesiology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33136, USA
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Scott IU, Gayer S, Voo I, Flynn HW, Diniz JR, Venkatraman A. Regional Anesthesia With Monitored Anesthesia Care for Surgical Repair of Selected Open Globe Injuries. Ophthalmic Surg Lasers Imaging Retina 2005. [DOI: 10.3928/1542-8877-20050301-08] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- D David
- Rabies Laboratory, Pathology Department, Kimron Veterinary Institute, PO Box 12, Bet Dagan 50250, Israel
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Gayer S, Cass GD. Sub-Tenon techniques should be one option among many. Anesthesiology 2003; 100:196; author reply 197. [PMID: 14695749 DOI: 10.1097/00000542-200401000-00041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marcus EN, Gayer S, Anderson DR. Medical evaluation of patients before ocular surgery. Am J Ophthalmol 2003; 136:338-9. [PMID: 12888058 DOI: 10.1016/s0002-9394(03)00205-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Steven Gayer
- Department of Anesthesiology, Perioperative Medicine, and Pain Management, 1611 NW 12th Avenue Central Building, Room 301, Miami, FL 33136, USA
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Scott IU, Mccabe CM, Flynn HW, Lemus DR, Schiffman JC, Reynolds DS, Pereira MB, Belfort A, Gayer S. Local anesthesia with intravenous sedation for surgical repair of selected open globe injuries. Am J Ophthalmol 2002; 134:707-11. [PMID: 12429247 DOI: 10.1016/s0002-9394(02)01692-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report factors associated with the use of local anesthesia with intravenous sedation (local anesthesia/sedation) rather than general anesthesia for surgery for open globe injuries in adult reparable eyes. DESIGN Retrospective, nonrandomized, comparative case series. METHODS Medical records were reviewed of all patients with open globe injuries repaired at Bascom Palmer Eye Institute between 1995 and 1999. "Adult reparable eyes" (eyes in patients >/=18 years of age, not treated with primary enucleation or evisceration, followed up >/=2 months) were included. RESULTS In all, 220 eyes of 218 patients met inclusion criteria. General anesthesia was employed in 80 of 200 (36%) and local anesthesia/sedation in 140 of 220 (64%). Patients who had local anesthesia/sedation were significantly more likely to have an intraocular foreign body (31% vs 14%; P =.010, chi-square test), better presenting visual acuity (1.8 logMAR [logarithm of the minimum angle of resolution] units vs 2.5 logMAR units; P <.001, t test), more anterior wound location (75% corneal/limbal vs 65%; P =.003, chi-square), shorter wound length (6.3mm vs 10.8mm; P <.001, t test), and dehiscence of previous surgical wound (26% vs 12%; P =.021, chi-square) and were significantly less likely to have an afferent pupillary defect (22% vs 51%; P <.001, chi-square). There was no anesthesia-related complication in either group. The local anesthesia/sedation group had a shorter mean operating time than did the general anesthesia group (78 minutes vs 117 minutes; P <.001, t test). The general anesthesia group had a longer mean follow-up than the local anesthesia/sedation group (20.2 months vs 13.9 months, respectively; P =.002, t test). Change in visual acuity between the presenting and final examinations was similar for open globe injuries repaired with general anesthesia compared with local anesthesia/sedation (0.94 vs 0.72 logMAR units of visual acuity, respectively; P =.16, t test). CONCLUSIONS Local anesthesia/sedation is a reasonable alternative to general anesthesia for selected patients with open globe injuries.
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Affiliation(s)
- Ingrid U Scott
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, School of Medicine, Miami, Florida 33101, USA.
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Abstract
We describe a girl with eosinophilic cellulitis (Wells syndrome) in whom the disease appeared immediately after birth with subcutaneous nodules on the scalp and trunk, followed by the characteristic skin swelling and erythema at the age of 6 months. The lesions disappeared after a few weeks, but recurred several times. The mother had consumed large quantities of medications during the pregnancy, including iron, vitamins, and "natural remedies." Based on time of onset, this may be regarded as a unique case of congenital Wells syndrome. Its relation to the medications taken by the mother remains speculative. Subcutaneous nodules may be the presenting sign of Wells syndrome in children.
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Affiliation(s)
- B Z Garty
- Department of Pediatrics, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel
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