Snoring is associated with unexpected patient head movement during monitored anesthesia care vitreoretinal surgery.

PURPOSE: To assess whether snoring is associated with sudden patient movement during local anesthesia with intravenous sedation. METHODS: In this prospective cohort study, patients undergoing ocular surgery with local anesthesia with intravenous sedation were studied. The occurrence or absence of snoring, and whether patient movement was noted were prospectively recorded. Complications that arose from patient movement were also noted. RESULTS: A total of 230 surgical procedures were included in the study. All cases were vitreoretinal surgery cases. During 37 procedures, snoring was noted, and among these, 18 patients (48.6%) moved their head suddenly. In contrast, movement occurred during only 2 of 193 procedures (1.0%) without documented snoring (P < 0.001). Thus, sudden patient head movement was approximately 49 times more prevalent in patients who snored. Continuous infusion propofol was also associated with sudden unexpected head movement (P = 0.0028). No complications as a result of the movement were identified in this study. CONCLUSION: Snoring during local anesthesia with intravenous sedation predicts a high likelihood of sudden patient movement during local anesthesia with intravenous sedation. The use of continuous infusion propofol anesthetic may increase the chance of head movement. Eye surgeons should be aware of these associations to help minimize the risk of complications caused by patient movement.

The 2012-2013 influenza epidemic and the role of osteopathic manipulative medicine.

The 2012-2013 influenza epidemic arrived approximately 4 weeks early, augmented by an unusual variant type-A ("swine flu") strain that caused greater-than-normal illness and a lack of efficacy in vaccination against it. Tens of thousands of people die of influenza or related complications during a nonepidemic influenza season. Osteopathic medicine can substantially help to address the complications that result from influenza. For example, during the deadly 1918-1919 Spanish influenza pandemic, osteopaths reduced patient mortality and morbidity by using lymphatic treatment techniques. Use of osteopathic manipulative treatment with vaccination, antiviral therapy, and chemoprophylaxis has potential to save lives and reduce complications. The present article describes the role of osteopathic manipulative treatment in the management of influenza and highlights current issues surrounding the use of antiviral therapy.