Tonic down-rolling and eccentric down-positioning of eyes under sevoflurane anesthesia without non-depolarizing muscle relaxant and its relationship with depth of anesthesia.

Purpose: To analyze the relationship between eccentric downward eye movement/eccentric downward eye-positioning (EDEM/EDEP) encountered in patients undergoing ophthalmic surgeries and its return to a centralized position under general anesthesia (GA) with the depth of anesthesia (DOA). Methods: Patients undergoing ophthalmic surgeries (6 months-12 years) under sevoflurane anesthesia without non-depolarizing muscle relaxant (NDMR) who witnessed a sudden tonic EDEM/EDEP were both retrospectively (R-group) and prospectively (P-group) enrolled (ambispective study). R-group included data-points after induction (AI) till the time surgery lasted while P-group compiled data both during induction (DI) and AI. DOA in terms of MAC (minimum alveolar concentration) at the time of EDEM/EDEP and centralization of eyeball and their timings were noted and compared for both AI and DI data-points. Also, vertical eccentric eye positions were scored and correlated with MAC. Results: AI data included 22 (14R+8P) events and their mean MAC of EDEM/EDEP and centralization were 1.60 ± 0.25 and 1.18 ± 0.17 respectively (p = 0.000). DI data included 62 (P) cases and its mean MAC of EDEM/EDEP and centralization was 2.19 ± 0.43 and 1.39 ± 0.26 respectively (p = 0.000). Median (IQR) eye positions during down-positioning in 84 events was -3 (-3.9 to -2.5). It was preceded by an eccentric upward drift of eyes in 10/22 (6R+4P) AI cases. A strong negative correlation was seen between DOA and eccentric eye positions (r = -0.77, p = 0.000). Conclusions: Tonic down-rolling of eyes is not uncommon in children seen without NDMR with higher depths of sevoflurane anesthesia compared to point of centralization and fluctuations in DOA should be avoided to circumvent inadvertent complications during ocular surgery.

Intraoperative absent bilateral medial recti in syndromic craniosynostosis.

Patients with syndromic craniosynostosis are usually associated with the complexity of the malformation complex. We describe here detailed oculo-motility disorder and a remarkable finding of hypoplastic bilateral media recti on imaging and its intraoperative absence in patients with phenotypic features resembling Shprintzen-Goldberg syndrome (SGS). SGS is a rare congenital disorder with craniosynostosis affecting multiple systems including mentation and having a considerable overlap of its phenotypic features with Marfan syndrome. Large A-pattern exotropia found in these patients may be related to the craniofacial features and their bearing on extraocular muscle development and function. In this paper, we aimed to sensitise ophthalmologists and strabismologists concerning the necessity to recognise syndromic associations of patients with craniosynostosis presenting with a large squint, be aware of the intraoperative surprises and consider the challenges in its management.

Seasonal variations of airborne pollen in Allahabad, India.

Using a Burkard 7-day volumetric sampler a survey of airborne pollen grains in Allahabad was carried out from December 2004--November 2005 to assess the qualitative and quantitative occurrence of pollen grains during different months of the year, and to characterize the pollen seasons of dominant pollen types in the atmosphere of Allahabad. 80 pollen types were identified out of the total pollen catch of 3,416.34 pollen grains/m(3). Bulk of the pollen originated from anemophilous trees and grasses. Thirteen pollen types recorded more than 1 % of the annual total pollen catch. Holoptelea integrifolia formed the major component of the pollen spectrum constituting 46.21 % of the total pollen catch followed by Poaceae, Azadirachta indica, Ailanthus excelsa, Putranjiva roxburghii, Parthenium hysterophorus, Ricinus communis, Brassica compestris, Amaranthaceae/Chenopodiaceae, Madhuca longifolia, Syzygium cumini, other Asteraceae and Aegle marmelos. Highest pollen counts were obtained in the month of March and lowest in July. The pollen types recorded marked the seasonal pattern of occurrence in the atmosphere. February-May was the principal pollen season with maximum number of pollen counts and pollen types. Chief sources of pollen during this period were arboreal taxa. September-October was the second pollen season with grasses being the main source of pollen. Airborne pollen spectrum reflected the vegetation of Allahabad, except for Alnus sp., which grows in the Himalayan region. A significant negative correlation was found of daily pollen counts with minimum temperature, relative humidity and rainfall.