The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study.

BACKGROUND: A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality. METHODS: A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch's t-test assuming unequal variance and Z test of comparison of proportions. RESULTS: Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P < 0.05 was used consistently. CONCLUSIONS: Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times, and with having received a retrobulbar block. Patients without a history of PTSD were more likely to have received topical anesthesia with or without sedation. The veteran population requires more sedation to allay anxiety and perceptions of discomfort, which may account for longer surgical times. The veteran population is a special population and it is important to investigate how PTSD in the veteran population affects intra-operative analgesia.

Long-term potency, sterility, and stability of vancomycin, ceftazidime, and moxifloxacin for treatment of bacterial endophthalmitis.

PURPOSE: To determine the long-term potency, sterility, and stability of vancomycin, ceftazidime, and moxifloxacin prepared in single-use polypropylene syringes for intravitreal injection. METHODS: Experimental study. Vancomycin 1 mg/0.1 mL, ceftazidime 2 mg/0.1 mL, and moxifloxacin 160 µg/0.1 mL were compounded and prepared in 1-mL polypropylene syringes and stored at 4 °C, -20 °C, and -80 °C. Antibiotic potency, sterility, pH, osmolality, and concentration were tested at baseline and at 1, 2, 4, 8, 12, and 24 weeks after preparation. RESULTS: Potency, sterility, and stability were preserved for all 3 antibiotics at all temperatures out to 24 weeks, although there was a trend toward reduced potency at Week 24 for vancomycin and ceftazidime stored at 4°C. The largest zones of inhibition for Staphylococcus epidermidis and S. aureus were consistently demonstrated by moxifloxacin. CONCLUSION: Vancomycin, ceftazidime, and moxifloxacin prepared in single-use polypropylene syringes retain potency, sterility, and stability out to 24 weeks when stored at -20 °C or -80 °C. The results of this study may have important implications for the current management of endophthalmitis.