Subject(s)
Retinal Artery Occlusion , Retinal Artery , Retinal Vein Occlusion , Toxoplasma , Toxoplasmosis, Ocular , Angiography , Fluorescein Angiography , Humans , Retinal Artery Occlusion/diagnosis , Retinal Artery Occlusion/etiology , Tomography, Optical Coherence , Toxoplasmosis, Ocular/complications , Toxoplasmosis, Ocular/diagnosisABSTRACT
Factor V is a pro-coagulant cofactor required for the transformation of prothrombin into thrombin. Thrombin activates factor V, which is then deactivated by protein C. A mutation in factor V is responsible for the formation of factor V Leiden, resistant to activated protein C. The association of this mutation with venous thromboses has been established. Its association with arterial occlusions is still controversial. We report the case of a central retinal artery occlusion associated with a non-arteritic anterior optic neuropathy associated with a Leiden mutation of factor V (FVL). The presence of FVL has been associated with lack of reperfusion and rapid progression to neovascularization. It seems that FVL intervenes mainly during the reperfusion phase after the occurrence of arterial thrombosis.
Subject(s)
Activated Protein C Resistance/diagnosis , Factor V/genetics , Mutation , Optic Neuropathy, Ischemic/diagnosis , Retinal Artery Occlusion/diagnosis , Activated Protein C Resistance/complications , Activated Protein C Resistance/genetics , Fluorescein Angiography , Heterozygote , Humans , Male , Middle Aged , Optic Neuropathy, Ischemic/complications , Optic Neuropathy, Ischemic/genetics , Retinal Artery Occlusion/complications , Retinal Artery Occlusion/genetics , Tomography, Optical CoherenceABSTRACT
The aim of this prospective, double-centre, observational study performed in 116 patients was to describe a new anterior approach of ultrasound-guided intermediate cervical plexus block for carotid endarterectomy. The median (IQR [range]) volume of ropivacaine 0.5% administered was 30 (25-30 [20-45]) ml. Supplemental local anaesthesia (infiltration and topical) was needed in 66 (57%) patients. Overall, 41 (35%) patients needed additional sedation (18 midazolam; 23 remifentanil). There was no intra-operative complication or systemic toxicity of ropivacaine. One regional anaesthesia procedure was converted to general anaesthesia because of patient agitation. Adverse effects were of short duration and did not affect surgery. Satisfaction scores were high for 92 (79%) patients (63 satisfied; 29 very satisfied) and 104 (90%) surgeons (51 satisfied; 53 very satisfied). This study shows that the ultrasound-guided intermediate cervical plexus block using an anterior approach is feasible and provides similar results to other regional techniques during carotid endarterectomy.
Subject(s)
Carotid Stenosis/surgery , Cervical Plexus Block/methods , Endarterectomy, Carotid/methods , Ultrasonography, Interventional/methods , Aged , Aged, 80 and over , Amides/administration & dosage , Anesthetics, Intravenous/administration & dosage , Carotid Stenosis/diagnostic imaging , Cervical Plexus/diagnostic imaging , Comorbidity , Feasibility Studies , Female , Humans , Male , Prospective Studies , RopivacaineABSTRACT
BACKGROUND: The analgesia/nociception index (ANI) is derived from heart rate variability, ranging from 0 (maximal nociception) to 100 (maximal analgesia), to reflect the analgesia/nociception balance during general anaesthesia. This should be correlated with immediate postoperative pain in the post-anaesthesia care unit (PACU). The aim of this study was to evaluate the performance of ANI measured at arousal from general anaesthesia to predict immediate postoperative pain on arrival in PACU. METHODS: Two hundred patients undergoing ear, nose, and throat or lower limb orthopaedic surgery with general anaesthesia using an inhalational agent and remifentanil were included in this prospective observational study. The ANI was measured immediately before tracheal extubation and pain intensity was assessed within 10 min of arrival in PACU using a 0-10 numerical rating scale (NRS). The relationship between ANI and NRS was assessed using linear regression. A receiver-operating characteristic (ROC) curve was used to evaluate the performance of ANI to predict NRS>3. RESULTS: A negative linear relationship was observed between ANI immediately before extubation and NRS on arrival in PACU. Using a threshold of <50, the sensitivity and specificity of ANI to discriminate between patients with NRS≤3 and NRS>3 were both 86% with 92% negative predictive value, corresponding to an area under the ROC curve of 0.89. CONCLUSIONS: The measurement of ANI immediately before extubation after inhalation-remifentanil anaesthesia was significantly associated with pain intensity on arrival in PACU. The performance of ANI for the prediction of immediate postoperative pain is good and may assist physicians in optimizing acute pain management. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT01796249.
