scholarly journals Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

2021 ◽  
Vol 10 (18) ◽  
pp. 4172
Author(s):  
Aleksandra Pluta ◽  
Michał Jan Stasiowski ◽  
Anita Lyssek-Boroń ◽  
Seweryn Król ◽  
Lech Krawczyk ◽  
...  
Keyword(s):  
Single Dose ◽  
Adverse Events ◽  
General Anesthesia ◽  
Pars Plana Vitrectomy ◽  
Postoperative Nausea And Vomiting ◽  
Incidence Rates ◽  
Secondary Outcome ◽  
Pars Plana ◽  
Topical Analgesia ◽  
Group Allocation

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.

Preemptive Sub-Tenon’s Anesthesia for Pars Plana Vitrectomy Under General Anesthesia: Is It Effective?

2008 ◽  
Vol 39 (5) ◽  
pp. 438-438
Author(s):  
William E Smiddy ◽  
Steven Gayer ◽  
John O Mason III ◽  
Peter L Goodwin ◽  
Richard M Feist ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Pars Plana Vitrectomy ◽  
Pars Plana

scholarly journals Higher incidence of adverse events in isolated patients compared with non-isolated patients: a cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035238
Author(s):  
Fátima Jiménez-Pericás ◽  
María Teresa Gea Velázquez de Castro ◽  
María Pastor-Valero ◽  
Carlos Aibar Remón ◽  
Juan José Miralles ◽  
...  
Keyword(s):  
Cohort Study ◽  
Adverse Events ◽  
Primary Outcome ◽  
Incidence Rates ◽  
University Hospital ◽  
Incidence Density ◽  
Secondary Outcome ◽  
National Study ◽  
Exclusion Criteria ◽  
Healthcare Associated

ObjectiveTo determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability.DesignProspective cohort study with isolated and non-isolated patients.SettingOne public university hospital in the Valencian Community (southeast Spain).ParticipantsWe consecutively collected 400 patients, 200 isolated and 200 non-isolated, age ≥18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. Exclusion criteria: patients age <18 years old and/or reverse isolation patients.Primary and secondary outcome measuresThe primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated.ResultsThe incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000 days/patient (95% CI 7.8 to 15.9) compared with 4.3 per 1000 days/patient (95% CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients).ConclusionsAEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient.

Preemptive Sub-Tenon’s Anesthesia for Pars Plana Vitrectomy Under General Anesthesia: Is It Effective?

2007 ◽  
Vol 38 (3) ◽  
pp. 203-208 ◽  
Author(s):  
John O. Mason III ◽  
Peter L. Goodwin ◽  
Richard M. Feist ◽  
Rachel S. Vail
Keyword(s):  
General Anesthesia ◽  
Pars Plana Vitrectomy ◽  
Pars Plana

Postoperative Effects of Continuous Dexmedetomidine Infusion During Gynecological Laparoscopy: A Randomized, Placebo-Controlled, Double-Blind, Single Center Clinical Trial

2020 ◽  
Author(s):  
SiYuan Liu ◽  
Binbin Wang ◽  
Yongtao Gao ◽  
Xingguo Xu
Keyword(s):  
Adverse Events ◽  
General Anesthesia ◽  
Outcome Measures ◽  
Normal Saline ◽  
Saline Group ◽  
Secondary Outcome ◽  
Double Blind ◽  
Gynecological Laparoscopy ◽  
Blood Pressures ◽  
Group D

Abstract Background: Dexmedetomidine(DEX) has proven to be an effective adjuvant to anesthetics owing to its sympatholytic, analgesic, and sedative properties. This study was designed to investigate the postoperative effects of continuous DEX infusion during gynecological laparoscopy and to evaluate the safety of this treatment. Methods: Sixty patients undergoing selective gynecological laparoscopy with general anesthesia were randomly assigned into DEX group (group D )and normal saline group (group N). DEX was infused at 0.5ug/kg/h during anesthesia maintenance in group D while normal saline was infused at the same rate in group N. The primary outcome measures were heart rate and blood pressure at extubation, 1, 2, 3, 4, 5, 6, 7, 8, 12, 24 and 48 hours after operation, NRS scores at 1, 2, 3 ,4, ,8,12,24 hours after surgery and OAA/S scores after extubation. The secondary outcome measures were time to extubation, propofol and remifentanil dosage during anesthesia, postoperative adverse events, and postoperative hospital stay.Results: Systolic and diastolic blood pressures were lower in group D at extubation when compared with group N (P<0.05), but not different at the first postoperative hour or after. HR was lower both at extubation and the first postoperative hour in group D (P<0.05). NRS scores were lower in patients given DEX both at rest and movement at the first postoperative hour (P<0.05). Time to extubation and OAA/S scores after extubation were not different between groups. Postoperative respiratory depression, shivering and pruritus didn’t occur in this research. There were no significant differences in the incidence rate of postoperative adverse events or postoperative hospital stay between the groups.Conclusions: Continuous infusion of DEX during gynecological laparoscopy provided better hemodynamic stability at extubation and the effects on HR continued until 1 hour after operation. DEX administration was associated with lower NRS scores at the first postoperative hour without excessive sedation. DEX is a useful and safe adjuvant for general anesthesia during gynecological laparoscopy.

scholarly journals Surgical timing and presence of a vitreoretinal fellow on postoperative adverse events following pars plana vitrectomy

2018 ◽  
Vol 30 (1) ◽  
pp. 81-87
Author(s):  
Ryan A Shields ◽  
Cassie A Ludwig ◽  
Matthew A Powers ◽  
Jonathan D Tijerina ◽  
Ira H Schachar ◽  
...  
Keyword(s):  
Adverse Event ◽  
Adverse Events ◽  
Pars Plana Vitrectomy ◽  
Vitreous Hemorrhage ◽  
Adverse Event Rate ◽  
Start Time ◽  
School Of Medicine ◽  
Pars Plana ◽  
Independent Risk Factors ◽  
Postoperative Vitreous Hemorrhage

Introduction: To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. Methods: Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. Results: A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). Discussion: Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.

Is there a role for modified probiotics as beneficial microbes: a systematic review of the literature

2017 ◽  
Vol 8 (5) ◽  
pp. 739-754 ◽  
Author(s):  
L. Zorzela ◽  
S.K. Ardestani ◽  
L.V. McFarland ◽  
S. Vohra
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Safety Data ◽  
Probiotic Strain ◽  
Incidence Rates ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Treatment Trials ◽  
Probiotic Strains

Our objective was to conduct a systematic review and meta-analysis for the use of modified (heat-killed or sonicated) probiotics for the efficacy and safety to prevent and treat various diseases. Recent clinical research has focused on living strains of probiotics, but use in high-risk patients and potential adverse reactions including bacteremia has focused interest on alternatives to the use of live probiotics. We searched MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, CINAHL, Alt Health Watch, Web of Science, Scopus, PubMed, from inception to February 14, 2017 for randomised controlled trials involving modified probiotic strains. The primary outcome was efficacy to prevent or treat disease and the secondary outcome was incidence of adverse events. A total of 40 trials were included (n=3,913): 14 trials (15 arms with modified probiotics and 20 control arms) for the prevention of diseases and 26 trials (29 arms with modified probiotics and 32 control arms) for treatment of various diseases. Modified microbes were compared to either placebo (44%), or the same living probiotic strain (39%) or to only standard therapies (17%). Modified microbes were not significantly more or less effective than the living probiotic in 86% of the preventive trials and 69% of the treatment trials. Modified probiotic strains were significantly more effective in 15% of the treatment trials. Incidence rates of adverse events were similar for modified and living probiotics and other control groups, but many trials did not collect adequate safety data. Although several types of modified probiotics showed significant efficacy over living strains of probiotics, firm conclusions could not be reached due to the limited number of trials using the same type of modified microbe (strain, daily dose and duration) for a specific disease indication. Further research may illuminate other strains of modified probiotics that may have potential as clinical biotherapeutics.

scholarly journals Comparative study of combined vitrectomy with phacoemulsification versus vitrectomy alone for primary full-thickness macular hole repair

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christophe Valmaggia ◽  
Filip Kostadinov ◽  
Corina Lang ◽  
Josef Guber
Keyword(s):  
Visual Acuity ◽  
Pars Plana Vitrectomy ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Full Thickness ◽  
Closure Rate ◽  
Macular Holes ◽  
Pars Plana ◽  
23 Gauge ◽  
N 93

Abstract Background To assess the effectiveness and safety of 23-gauge pars plana vitrectomy combined with phacoemulsification versus vitrectomy alone in patients over 50 years with primary full-thickness macular holes (FTMH). Methods We retrospectively reviewed the medical records related to 406 consecutive vitrectomies performed for primary FTMH. Phacovitrectomy was performed in 294 phakic eyes whereas vitrectomy alone in 112 pseudophakic eyes. The cases were divided into three groups according to the stage of the FTMH: stage 2 (n = 93), stage 3 (n = 270), or stage 4 (n = 43). The primary outcome measure was the closure of the FTMH. The secondary outcome measures were the evolution of visual acuity as well as intraoperative and postoperative complications. Results Neither the primary nor the secondary outcomes differed between phacovitrectomy and vitrectomy alone for all three stages. The FTMH were closed in 375 eyes (92.4 %) after a first operation. The closure rate was higher for stage 2 (96.8 %) than for stages 3 (91.1 %) or 4 (90.75 %), but not significantly (P = 0.189). The mean visual acuity increased significantly from preoperatively LogMAR 0.68 (± SD 0.2) to LogMAR 0.43 (± SD 0.24) at the end of the follow-up (p < 0.001). Conclusions Combined 23-gauge pars plana vitrectomy with phacoemulsification for primary FTMH repair in patients over 50 years is as efficient and safe when compared with vitrectomy only. Trial registration The study was approved on 30th April 2020 by the local ethics committee (Ethikkommission Ostschweiz, EKOS 20/074; BASEC Nr. 2020-01033).

scholarly journals Comparing the Effects of Dexmedetomidine versus Propofol on the Treatment of Emergence Agitation in Adults after General Anesthesia: study protocol for a randomized controlled trial (DP-TEA Trial)

2021 ◽  
Author(s):  
Zhaoyan Feng ◽  
Xiao Shi ◽  
Xue Yan ◽  
Yamin Zhu ◽  
Juan Gu ◽  
...  
Keyword(s):  
Single Dose ◽  
General Anesthesia ◽  
Controlled Trial ◽  
Postoperative Nausea And Vomiting ◽  
Medication Administration ◽  
Adult Patients ◽  
Nausea And Vomiting ◽  
Emergence Agitation ◽  
Randomized Controlled

Abstract BackgroundEmergence agitation (EA) from general anesthesia is a common complication in the post anesthesia care unit (PACU). Once EA happens, there is still no guidelines established to recommend the medication administration in adults. Propofol is widely used in managing agitated patient in the PACU, but it is lack of analgesia and can suppress breathing transiently. Intraoperative infusion of dexmedetomidine is proved to have preventive effect on EA, but the treatment effect of dexmedetomidine on EA occurring in the PACU remains unknown. This study aims to compare the effects between dexmedetomidine and propofol on relieving emergence agitation in the PACU in adult patients after general anesthesia. MethodsIn this randomized, controlled, single-blinded clinical study, a total of 120 adult patients aged 18-65 years of both genders, with American Society of Anesthesiologists (ASA) classification I or II who develop emergence agitation in the PACU after general anesthesia will be included. Patients will be randomized at 1:1 ratio to two groups, receiving either a single dose of dexmedetomidine (0.7ug/kg) or propofol (0.5mg/kg). The primary outcome is the recurrence rate of EA assessed by the Riker Sedation-Agitation Scale (RSAS). The secondary outcomes are RSAS scores and vital signs before and after intervention, the consumption of sufentanil in the PACU, nausea and vomiting scores evaluated by a four-point postoperative nausea and vomiting (PONV) scale when leaving the PACU, duration in the PACU, adverse events (desaturation, severe bradycardia, shivering, dizziness, laryngospasm, severe coughing, reintubation) and recovering quality evaluated by the 40-item quality of recovery scale (Qo-R 40).DiscussionPrevious studies are almost about the efficacy of premedication on preventing EA, while medicine administration on treating EA is reported rarely. This study is designed to investigate whether a single dose of dexmedetomidine can relieve EA more efficiently and improve recovery quality of adult patients form general anesthesia more significantly comparing to propofol.Trial registrationClinicalTrials.gov ID: NCT04142840.Registered on October 26, 2019. https://clinicaltrials.gov/ct2/show/NCT04142840.

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