I shall never be ashamed of citing a bad author if the line is good'. Seneca, Roman dramatist, ph... more I shall never be ashamed of citing a bad author if the line is good'. Seneca, Roman dramatist, philosopher and politician (5 BC to 65 AD). We thank Zalcberg and Ben-Menachem 1 for their interest in our review article covering job satisfaction,
The successful use of the laryngeal mask airway in children partly depends on the correct selecti... more The successful use of the laryngeal mask airway in children partly depends on the correct selection of size. Most anaesthesiologists rely on the weight-based table which is often difficult to remember. A simple method allowing an adequate choice of the correct size may be highly desirable. To test the hypothesis that the size of the external ear (pinna) of the child may be used as proxy for the required size of laryngeal mask airway. A descriptive study. King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Two hundred and ten paediatric patients aged 6 months to 15 years, of either sex, American Society of Anesthesiologists (ASA) 1-2 and scheduled for routine ophthalmological procedures from 1 March to 31 December 2010. Emergency cases, patients with a full stomach or with a history of any oropharyngeal lesion other than tonsillar hypertrophy were excluded. The size of the external ear was measured with a ruler in vertical and horizontal dimensions in the first 30 patients, and visually evaluated for the remaining patients. For all, the nearest corresponding size of partially inflated laryngeal mask airway was chosen and inserted after induction. The correct placement was assessed using predefined criteria. Insertion and good ventilation was achieved in 196 (93.3%) on first attempt. Fourteen patients (6.7%) required a second attempt and the main reason for failure was an audible leak because of smaller size. Choosing the size of the laryngeal mask airway in children according to the size of the external ear was associated with a success rate of 93% which is comparable with that reported in the literature when the tables are used. This simple method may allow a rapid choice of the correct size of laryngeal mask airway and may eliminate the need to remember different tables or formulae.
Introduction: Peribulbar anesthesia with short needle is minimally invasive approach for intraocu... more Introduction: Peribulbar anesthesia with short needle is minimally invasive approach for intraocular surgery, associated with less blocks related complications. CASE REPORT: 55 years old woman scheduled for phacoemulsification with posterior chamber intraocular lens implantation, under local anesthesia. She was taking Aspirin, NSAID, besides diabetes and hypertensive medications.16 mm length 25 G needle used for peibulba block via infero temporal approach. Ten ml mixture of Lidocaine 2%, Bupivicaine 0.5% in a 2:3 volume ratio with Hyaluronidase 5 IU/ml was used for block. Patient felt intense pain in eye after 5 minutes. Globe was proptotic with tension in the upper and lower eyelids. Emergency lateral canthotomy was performed. Subconjunctival hematoma was drained. CT scan orbit showed left periorbital soft tissue swelling with abnormal extraconal density in close proximity to left lateral rectus muscle. Initial density was 18 to 40 Hounsfield units with length 2.9 cm and width 0.6 cm. It was organised subperiostal hematoma. DISCUSSION: Hematoma was developed by short needle that violated the orbital periosteium. Blood have dissected subperiosteal space coming from inferolateral subgaleal space. Coronal, Axial CT of orbits showed extraconal density in close proximity to left lateral rectus muscle, suggesting organised subperiostal hematoma. Patient developed increased orbital pressure with pain, proptosis, ecchymosis, bloody conjunctival chemosis, and increased intraocular pressure. We performed an emergency lateral canthotomy to decompress intraocular chamber, otherwise, irreversible visual loss could have been caused, the patient's eye and vision was saved by prompt surgical intervention. Visual acuity was found similar to the one before the complication on follow up visits.
To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospit... more To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospital stay following the use of topical oxybuprocaine hydrochloride 0.4% or intravenous (IV) fentanyl in children undergoing strabismus surgery. Methods: This was a prospective cohort study. Children operated under general anesthesia for strabismus were given topical oxybuprocaine hydrochloride 0.4% (Group T) and IV fentanyl (Group F) before surgery. The episodes of nausea/vomiting, pain score, requirement of additional analgesia during postoperative period, and duration of hospital stay were compared in two groups. Results: There were 47 children in Group T and 59 children in Group F. The median pain score in two groups were 2.38 (25% quartile; 2.0) and 3.00 (25% quartile; 3.00), respectively. The difference was significant (K W P < 0.03). The episodes of nausea/vomiting in two groups were in 2 and 6 children in Group T and Group F, respectively. The median hospital stay of children of Group T and Group F were 242 and 285 min, respectively. The difference was not statistically significant (P = 0.22). Conclusions: Using intraoperative topical oxybuprocaine drops, one can achieve better analgesic outcomes and reduce risk of nausea and vomiting compared to intravenous opioid analgesics and therefore, the hospital stay could also be marginally reduced.
The outbreak of the novel coronavirus (COVID-19) has been declared a global pandemic. With a mort... more The outbreak of the novel coronavirus (COVID-19) has been declared a global pandemic. With a mortality rate reaching up to 5%, healthcare professionals treating patients with COVID-19 are at a significantly higher risk for exposure themselves. Given the rapidly progressing rate of COVID-19, there is an urgent need for developing guidelines within each specialty. This article discusses guidelines specifically for anesthesiologists dealing with ophthalmic surgeries with suspected or confirmed COVID-19 patients. Anesthesiologists always work in the proximity of the patient's face while performing either ocular regional anesthesia or while managing the airway in the process of intubation/extubation. Within these guidelines, the emphasis is provided on thorough preoperative screening to identify COVID-19 patients and to prevent the exposure of healthcare staff by following standard personal protective equipment (PPE) precautions.
Middle East African Journal of Ophthalmology, 2012
S uperficial extraconal blockade for cataract surgery is an effective method for intraoperative a... more S uperficial extraconal blockade for cataract surgery is an effective method for intraoperative and postoperative analgesia. 1 Use of a short acting amide, lidocaine, mixed with a longer acting bupivacaine is a popular combination to produce optimal effects for cataract surgery. 2 Bupivacaine is highly lipid-soluble, and contains a chiral center on the piperidine ring, resulting in two optically active stereoisomers, dextrobupivacaine, or levobupivacaine S (-) bupivacaine. 3 It is well known that racemic bupivacaine has a narrow therapeutic index and carries a higher risk for cardiotoxicity. 4 Levobupivacaine has high pKa value and low lipid solubility with a clinical profile very similar to bupivacaine in providing effective anesthesia and analgesia. 2
The flexible fiberoptic endoscope is invaluable equipment used in the practice of anaesthesiology... more The flexible fiberoptic endoscope is invaluable equipment used in the practice of anaesthesiology and intensive care medicine. Its basic use is as an aid to difficult intubation either by the oral or nasotracheal route. A few numbers of cases of Retrograde-Assisted Fiberoptic Intubation have been reported in the literature. We report a similar case. CASE REPORT A 42-year-old male patient was scheduled for elective right total hip replacement.
To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospit... more To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospital stay following the use of topical oxybuprocaine hydrochloride 0.4% or intravenous (IV) fentanyl in children undergoing strabismus surgery. This was a prospective cohort study. Children operated under general anesthesia for strabismus were given topical oxybuprocaine hydrochloride 0.4% (Group T) and IV fentanyl (Group F) before surgery. The episodes of nausea/vomiting, pain score, requirement of additional analgesia during postoperative period, and duration of hospital stay were compared in two groups. There were 47 children in Group T and 59 children in Group F. The median pain score in two groups were 2.38 (25% quartile; 2.0) and 3.00 (25% quartile; 3.00), respectively. The difference was significant (K W P < 0.03). The episodes of nausea/vomiting in two groups were in 2 and 6 children in Group T and Group F, respectively. The median hospital stay of children of Group T and Group ...
To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula... more To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery. This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant. There were sixty patients in each group. The age between groups was not statistically different (P = 0.4). The body mass index was higher in the ST group compared to the OT group (P < 0.001). The akinesia score at 5 and 10 min did not differ between groups (P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups (P = 0.1...
Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compar... more Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compare the efficacy of using 12.5 mm to 25 mm standard needle length in performing single injection peribulbar block for retinal surgery. Peribulbar block was performed in 120 patients using either standard 25 mm or 12.5 mm 30 G needle (insulin needle). While applying digital pressure around the needle hub, 8–10 mL of local anesthetic are injected. Ocular movement was assessed at 5 and 10 min using simple akinesia score (0–8). If after 10 min score was >1, supplementary injection was given. Visual analogue scale (0–10) was used at the end of the procedure to assess surgeons’ satisfaction and patients’ intraoperative pain. No differences in akinesia score at 5 & 10 min (P=0.34and 0.36, resp.). Initial volume injected was comparable between groups (P=0.31), however total volume of local anesthesia and supplementary injections were significantly higher in 12.5 mm group (P=0.03and 0.01, resp.)...
To set up and validate a patient satisfaction questionnaire based on Iowa Satisfaction in Anesthe... more To set up and validate a patient satisfaction questionnaire based on Iowa Satisfaction in Anesthesia Scale (ISAS) for evaluating the degree of patient satisfaction in anesthesia. We established and validated a survey questionnaire of 13 questions measuring the following dimensions adequacy of patient information; participation in decision making, nurse patient relation, accessibility of communication with the anesthesiologist, patient fear and anxiety and the post anesthesia care management. The process passed through three steps: instrument validation, survey conduction and data analysis. Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha was used to measure the reliability and standard psychometric techniques were used to measure instrument validity. Our modified instrument shows good reliability which is obvious with a Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha value of 0.72 and all the perspectives of validity (face, content and construct). Also, 173 (21.54%) patients achieved an overall satisfaction score of less than 85% female patients are were less satisfied than male patients. Educated patients were less satisfied, and those belonging to ASA group I and II were significantly less satisfied. Dimensions pinpointed are related to information and decision making, adverse events in recovery room, fear and anxiety contributed to patient dissatisfaction. The instrument used for the evaluation of patient satisfaction in anesthesia is a valid tool for the Arabic speaking patients. There is room for improvement in the anesthesia care, mainly in the dimension of information, decision making and postoperative anesthesia care.
Bleeding and intraorbital hematoma is one of the most common complications of needle block for op... more Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. detailed management to improve the outcome is discussed.
Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP), tachyc... more Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP), tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy. The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation. After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation. IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation (P = 0.217, 0.726, and 0.110 respectively). The only significant difference in IOP was at 1 min after intubation (P = 0.041). No significant difference noted between groups in mean arterial pressure (P = 0.899, 0.62, 0.47, 0.82 respectively) and heart rate (P = 0.21, 0.72, 0.07, 0.29, respectively) at all measurements. GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope.
Bleeding and intraorbital hematoma is one of the most common complications of needle block for op... more Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. detailed management to improve the outcome is discussed.
Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with... more Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test was used to determine the significance of IOWA score in both groups. P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 was considered significant. Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.
Middle East African Journal of Ophthalmology, 2012
To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia... more To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia with levobupivacaine 0.5% versus bupivacaine 0.5%, both combined with lidocaine 2% for patients undergoing phacoemulsification. In this prospective, double blind study, 150 patients were randomly divided into two groups: group-1 received a Peribulbar block (PB) with a mixture of evobupivacaine 0.5% and lidocaine 2% while group-2 received a PB with a mixture of bupivacaine 0.5% and lidocaine 2%. The block was performed by insertion of a short needle (15 mm) in infra-temporal space just above inferior orbital notch. An initial volume of 6 9 ml of either mixture was injected until total upper eyelid drop. Akinesia score was assessed at 2, 5, and 10 min after the block. The degree of pain was assessed by a verbal rating scale immediately after block, at the end of surgery and 4 h postoperatively. The patients and surgeons were asked to rate their satisfaction level of the quality of block postoperatively. Data were analyzed with the unpaired, two-tailed t-test and the Chi-square test as appropriate. P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 was considered statistically significant. There were no significant differences between groups with respect to the akinesia score (P = 0.2) at 2, 5, and 10 min, the number of supplementary injections (P = 0.84) and initial and total required volume of local anesthetics (P = 0.80 and 0.81, respectively). There was no significant difference between the groups regarding surgeon and patient satisfaction (P = 0.53 and P = 0.74, respectively). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05 all cases). The need for additional intra-operative topical anesthetic was also similar between the groups. (P = 0.69). Superficial extra-conal block with a mixture of levobupivicaine 0.5% and lidocaine 2% or bupivicaine 0.5% and lidocaine 2% provides similar block quality and efficacy.
I shall never be ashamed of citing a bad author if the line is good'. Seneca, Roman dramatist, ph... more I shall never be ashamed of citing a bad author if the line is good'. Seneca, Roman dramatist, philosopher and politician (5 BC to 65 AD). We thank Zalcberg and Ben-Menachem 1 for their interest in our review article covering job satisfaction,
The successful use of the laryngeal mask airway in children partly depends on the correct selecti... more The successful use of the laryngeal mask airway in children partly depends on the correct selection of size. Most anaesthesiologists rely on the weight-based table which is often difficult to remember. A simple method allowing an adequate choice of the correct size may be highly desirable. To test the hypothesis that the size of the external ear (pinna) of the child may be used as proxy for the required size of laryngeal mask airway. A descriptive study. King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Two hundred and ten paediatric patients aged 6 months to 15 years, of either sex, American Society of Anesthesiologists (ASA) 1-2 and scheduled for routine ophthalmological procedures from 1 March to 31 December 2010. Emergency cases, patients with a full stomach or with a history of any oropharyngeal lesion other than tonsillar hypertrophy were excluded. The size of the external ear was measured with a ruler in vertical and horizontal dimensions in the first 30 patients, and visually evaluated for the remaining patients. For all, the nearest corresponding size of partially inflated laryngeal mask airway was chosen and inserted after induction. The correct placement was assessed using predefined criteria. Insertion and good ventilation was achieved in 196 (93.3%) on first attempt. Fourteen patients (6.7%) required a second attempt and the main reason for failure was an audible leak because of smaller size. Choosing the size of the laryngeal mask airway in children according to the size of the external ear was associated with a success rate of 93% which is comparable with that reported in the literature when the tables are used. This simple method may allow a rapid choice of the correct size of laryngeal mask airway and may eliminate the need to remember different tables or formulae.
Introduction: Peribulbar anesthesia with short needle is minimally invasive approach for intraocu... more Introduction: Peribulbar anesthesia with short needle is minimally invasive approach for intraocular surgery, associated with less blocks related complications. CASE REPORT: 55 years old woman scheduled for phacoemulsification with posterior chamber intraocular lens implantation, under local anesthesia. She was taking Aspirin, NSAID, besides diabetes and hypertensive medications.16 mm length 25 G needle used for peibulba block via infero temporal approach. Ten ml mixture of Lidocaine 2%, Bupivicaine 0.5% in a 2:3 volume ratio with Hyaluronidase 5 IU/ml was used for block. Patient felt intense pain in eye after 5 minutes. Globe was proptotic with tension in the upper and lower eyelids. Emergency lateral canthotomy was performed. Subconjunctival hematoma was drained. CT scan orbit showed left periorbital soft tissue swelling with abnormal extraconal density in close proximity to left lateral rectus muscle. Initial density was 18 to 40 Hounsfield units with length 2.9 cm and width 0.6 cm. It was organised subperiostal hematoma. DISCUSSION: Hematoma was developed by short needle that violated the orbital periosteium. Blood have dissected subperiosteal space coming from inferolateral subgaleal space. Coronal, Axial CT of orbits showed extraconal density in close proximity to left lateral rectus muscle, suggesting organised subperiostal hematoma. Patient developed increased orbital pressure with pain, proptosis, ecchymosis, bloody conjunctival chemosis, and increased intraocular pressure. We performed an emergency lateral canthotomy to decompress intraocular chamber, otherwise, irreversible visual loss could have been caused, the patient's eye and vision was saved by prompt surgical intervention. Visual acuity was found similar to the one before the complication on follow up visits.
To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospit... more To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospital stay following the use of topical oxybuprocaine hydrochloride 0.4% or intravenous (IV) fentanyl in children undergoing strabismus surgery. Methods: This was a prospective cohort study. Children operated under general anesthesia for strabismus were given topical oxybuprocaine hydrochloride 0.4% (Group T) and IV fentanyl (Group F) before surgery. The episodes of nausea/vomiting, pain score, requirement of additional analgesia during postoperative period, and duration of hospital stay were compared in two groups. Results: There were 47 children in Group T and 59 children in Group F. The median pain score in two groups were 2.38 (25% quartile; 2.0) and 3.00 (25% quartile; 3.00), respectively. The difference was significant (K W P < 0.03). The episodes of nausea/vomiting in two groups were in 2 and 6 children in Group T and Group F, respectively. The median hospital stay of children of Group T and Group F were 242 and 285 min, respectively. The difference was not statistically significant (P = 0.22). Conclusions: Using intraoperative topical oxybuprocaine drops, one can achieve better analgesic outcomes and reduce risk of nausea and vomiting compared to intravenous opioid analgesics and therefore, the hospital stay could also be marginally reduced.
The outbreak of the novel coronavirus (COVID-19) has been declared a global pandemic. With a mort... more The outbreak of the novel coronavirus (COVID-19) has been declared a global pandemic. With a mortality rate reaching up to 5%, healthcare professionals treating patients with COVID-19 are at a significantly higher risk for exposure themselves. Given the rapidly progressing rate of COVID-19, there is an urgent need for developing guidelines within each specialty. This article discusses guidelines specifically for anesthesiologists dealing with ophthalmic surgeries with suspected or confirmed COVID-19 patients. Anesthesiologists always work in the proximity of the patient's face while performing either ocular regional anesthesia or while managing the airway in the process of intubation/extubation. Within these guidelines, the emphasis is provided on thorough preoperative screening to identify COVID-19 patients and to prevent the exposure of healthcare staff by following standard personal protective equipment (PPE) precautions.
Middle East African Journal of Ophthalmology, 2012
S uperficial extraconal blockade for cataract surgery is an effective method for intraoperative a... more S uperficial extraconal blockade for cataract surgery is an effective method for intraoperative and postoperative analgesia. 1 Use of a short acting amide, lidocaine, mixed with a longer acting bupivacaine is a popular combination to produce optimal effects for cataract surgery. 2 Bupivacaine is highly lipid-soluble, and contains a chiral center on the piperidine ring, resulting in two optically active stereoisomers, dextrobupivacaine, or levobupivacaine S (-) bupivacaine. 3 It is well known that racemic bupivacaine has a narrow therapeutic index and carries a higher risk for cardiotoxicity. 4 Levobupivacaine has high pKa value and low lipid solubility with a clinical profile very similar to bupivacaine in providing effective anesthesia and analgesia. 2
The flexible fiberoptic endoscope is invaluable equipment used in the practice of anaesthesiology... more The flexible fiberoptic endoscope is invaluable equipment used in the practice of anaesthesiology and intensive care medicine. Its basic use is as an aid to difficult intubation either by the oral or nasotracheal route. A few numbers of cases of Retrograde-Assisted Fiberoptic Intubation have been reported in the literature. We report a similar case. CASE REPORT A 42-year-old male patient was scheduled for elective right total hip replacement.
To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospit... more To compare the outcomes such as postoperative nausea/vomiting, analgesic requirements, and hospital stay following the use of topical oxybuprocaine hydrochloride 0.4% or intravenous (IV) fentanyl in children undergoing strabismus surgery. This was a prospective cohort study. Children operated under general anesthesia for strabismus were given topical oxybuprocaine hydrochloride 0.4% (Group T) and IV fentanyl (Group F) before surgery. The episodes of nausea/vomiting, pain score, requirement of additional analgesia during postoperative period, and duration of hospital stay were compared in two groups. There were 47 children in Group T and 59 children in Group F. The median pain score in two groups were 2.38 (25% quartile; 2.0) and 3.00 (25% quartile; 3.00), respectively. The difference was significant (K W P < 0.03). The episodes of nausea/vomiting in two groups were in 2 and 6 children in Group T and Group F, respectively. The median hospital stay of children of Group T and Group ...
To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula... more To compare the efficacy of the olive tipped (OT) cannula to the conventional Steven's cannula for sub-Tenon block (STB) before cataract surgery. This prospective, randomized, double-masked compared STB delivered in cataract surgery patients with an OT cannula or a conventional Steven's cannula (ST). Outcome variables included the akinesia score and lid movement scores at 5 and 10 min. The patient perception of pain during delivery of the STB and surgery were also compared between groups. Surgeon satisfaction with anesthesia was compared between groups. P <0.05 was statistically significant. There were sixty patients in each group. The age between groups was not statistically different (P = 0.4). The body mass index was higher in the ST group compared to the OT group (P < 0.001). The akinesia score at 5 and 10 min did not differ between groups (P = 0.07 and P = 0.6, respectively). The patient perception of pain during STB and surgery were similar between groups (P = 0.1...
Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compar... more Peribulbar block is commonly used for ocular posterior segment surgery. This work aimed to compare the efficacy of using 12.5 mm to 25 mm standard needle length in performing single injection peribulbar block for retinal surgery. Peribulbar block was performed in 120 patients using either standard 25 mm or 12.5 mm 30 G needle (insulin needle). While applying digital pressure around the needle hub, 8–10 mL of local anesthetic are injected. Ocular movement was assessed at 5 and 10 min using simple akinesia score (0–8). If after 10 min score was >1, supplementary injection was given. Visual analogue scale (0–10) was used at the end of the procedure to assess surgeons’ satisfaction and patients’ intraoperative pain. No differences in akinesia score at 5 & 10 min (P=0.34and 0.36, resp.). Initial volume injected was comparable between groups (P=0.31), however total volume of local anesthesia and supplementary injections were significantly higher in 12.5 mm group (P=0.03and 0.01, resp.)...
To set up and validate a patient satisfaction questionnaire based on Iowa Satisfaction in Anesthe... more To set up and validate a patient satisfaction questionnaire based on Iowa Satisfaction in Anesthesia Scale (ISAS) for evaluating the degree of patient satisfaction in anesthesia. We established and validated a survey questionnaire of 13 questions measuring the following dimensions adequacy of patient information; participation in decision making, nurse patient relation, accessibility of communication with the anesthesiologist, patient fear and anxiety and the post anesthesia care management. The process passed through three steps: instrument validation, survey conduction and data analysis. Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha was used to measure the reliability and standard psychometric techniques were used to measure instrument validity. Our modified instrument shows good reliability which is obvious with a Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha value of 0.72 and all the perspectives of validity (face, content and construct). Also, 173 (21.54%) patients achieved an overall satisfaction score of less than 85% female patients are were less satisfied than male patients. Educated patients were less satisfied, and those belonging to ASA group I and II were significantly less satisfied. Dimensions pinpointed are related to information and decision making, adverse events in recovery room, fear and anxiety contributed to patient dissatisfaction. The instrument used for the evaluation of patient satisfaction in anesthesia is a valid tool for the Arabic speaking patients. There is room for improvement in the anesthesia care, mainly in the dimension of information, decision making and postoperative anesthesia care.
Bleeding and intraorbital hematoma is one of the most common complications of needle block for op... more Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. detailed management to improve the outcome is discussed.
Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP), tachyc... more Traditional Macintoch laryngoscopy is known to cause a rise in intraocular pressure (IOP), tachycardia and hypertension. These changes are not desirable in patients with glaucoma and open globe injury. GlideScope is a video laryngoscope that functions independent of the line of sight, reduces upward lifting forces for glottic exposure and requires less cervical neck movement for intubation, making it less stimulating than Macintosh laryngoscopy. The aim was to assess the variations in IOP and hemodynamic changes after GlideScope assisted intubation. After approval of the local Institutional Research and Ethical Board and informed patient consent, 50 adult American Society of Anesthesiologist I and II patients with normal IOP were enrolled in a prospective, randomized study for ophthalmic surgery requiring tracheal intubation. In all patients, trachea was intubated using either GlideScope or Macintoch laryngoscope. IOP of nonoperated eye, heart rate and blood pressure were measured as baseline, 1 min after induction, 1 min and 5 min after tracheal intubation. IOP was not significantly different between groups before and after anesthetic induction and 5 min after tracheal intubation (P = 0.217, 0.726, and 0.110 respectively). The only significant difference in IOP was at 1 min after intubation (P = 0.041). No significant difference noted between groups in mean arterial pressure (P = 0.899, 0.62, 0.47, 0.82 respectively) and heart rate (P = 0.21, 0.72, 0.07, 0.29, respectively) at all measurements. GlideScope assisted tracheal intubation shown lesser rise in IOP at 1 min after intubation in comparison to Macintoch laryngoscope, suggesting that GlideScope may be preferable to Macintosh laryngoscope.
Bleeding and intraorbital hematoma is one of the most common complications of needle block for op... more Bleeding and intraorbital hematoma is one of the most common complications of needle block for ophthalmic local anesthesia. We describe an unusual presentation of hematoma that originated in the subperiosteal space and extended to the subconjunctival and periocular area after a peribulbar block for phacoemulsification in a 55-year-old lady. It required an urgent surgical evacuation in order to reduce the intraocular pressure and save the eye. detailed management to improve the outcome is discussed.
Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with... more Various studies have assessed patient satisfaction with topical versus peribulbar anesthesia with conflicting results. Aim of study was to determine satisfaction level in same patient who gets topical anesthesia in one eye and peribulbar block in another eye. We propose that evaluation of various indicators of patient satisfaction will enable better selection of cases for topical anesthesia in the future. Eighty patients scheduled for phacoemulsification were enrolled in prospective, randomized, double-blind study. Each patient scheduled twice for one eye under topical anesthesia and other in peribulbar block. Pain, discomfort and pressure during application of local anesthetic, during phacoemulsification and at 2 hours after procedure were assessed on standard scales. Before discharge patient satisfaction level was checked with Iowa satisfaction with anesthesia scale (ISAS). The Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t-test was used to determine the significance of IOWA score in both groups. P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05 was considered significant. Feeling of pain, pressure and discomfort scores during administration of topical anesthesia were all significantly lower compared to peribulbar anesthesia (P=0.004, 0.000, 0.002, respectively). In contrast, intraoperative scores were significantly higher in the topical anesthesia group compared to peribulbar anesthesia (P=0.022, 0.000, 0.000, respectively). Patient satisfaction measured with ISAS shows that peribulbar anesthesia with P=0.000 is strongly significant. Peribulbar anesthesia provided significantly better patient satisfaction in comparison with topical anesthesia when used for cataract surgery.
Middle East African Journal of Ophthalmology, 2012
To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia... more To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia with levobupivacaine 0.5% versus bupivacaine 0.5%, both combined with lidocaine 2% for patients undergoing phacoemulsification. In this prospective, double blind study, 150 patients were randomly divided into two groups: group-1 received a Peribulbar block (PB) with a mixture of evobupivacaine 0.5% and lidocaine 2% while group-2 received a PB with a mixture of bupivacaine 0.5% and lidocaine 2%. The block was performed by insertion of a short needle (15 mm) in infra-temporal space just above inferior orbital notch. An initial volume of 6 9 ml of either mixture was injected until total upper eyelid drop. Akinesia score was assessed at 2, 5, and 10 min after the block. The degree of pain was assessed by a verbal rating scale immediately after block, at the end of surgery and 4 h postoperatively. The patients and surgeons were asked to rate their satisfaction level of the quality of block postoperatively. Data were analyzed with the unpaired, two-tailed t-test and the Chi-square test as appropriate. P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05 was considered statistically significant. There were no significant differences between groups with respect to the akinesia score (P = 0.2) at 2, 5, and 10 min, the number of supplementary injections (P = 0.84) and initial and total required volume of local anesthetics (P = 0.80 and 0.81, respectively). There was no significant difference between the groups regarding surgeon and patient satisfaction (P = 0.53 and P = 0.74, respectively). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 0.05 all cases). The need for additional intra-operative topical anesthetic was also similar between the groups. (P = 0.69). Superficial extra-conal block with a mixture of levobupivicaine 0.5% and lidocaine 2% or bupivicaine 0.5% and lidocaine 2% provides similar block quality and efficacy.
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