The effects of diazepam on blood pressure levels in cataract surgery.

OBJECTIVE: To evaluate the effects of oral diazepam on blood pressure (BP) alterations in patients that underwent cataract surgery under topical anesthesia. METHODS: A total of 147 patients that underwent phacoemulsification surgery under topical anesthesia, were reviewed retrospectively. The study took place in the Department of Ophthalmology, Adnan Menderes University Medical Faculty, Aydin, Turkey, between January 2011 and July 2013. Patients were divided into 2 groups: Group 1: received 5 mg diazepam per oral one hour prior to surgery, and Group 2 (control group): none administered preoperatively. The BP readings of all patients were scanned through their files. Five readings were chosen for statistical analysis. The first reading was taken in the ophthalmology ward on the morning of the operation, the second was taken in the premedication room just before the surgery, 2 readings were taken intraoperatively and recorded as third and fourth values, and the fifth reading was recorded from those taken in the ophthalmology ward after surgery. RESULTS: Group 1 had a mean age of 62.17 +/- 10.01 years, while the Group 2 had a mean age of 64.31 +/- 10.88 years. There were no differences between the 2 groups by means of systolic and diastolic BP levels measured preoperatively in the ophthalmology ward. Intraoperative systolic and diastolic BP levels were significantly higher in Group 2 (p<0.001). CONCLUSION: Elevated BP can undermine surgical outcomes; and may lead to unforeseen complications. To prevent the elevation of BP to risky levels in the intraoperative period, diazepam administration may be beneficial, even in normotensive patients.

The incidence of postoperative residual curarization following the use of intermediate-acting muscle relaxants and related factors.

PURPOSE: To evaluate the incidence of residual curarization (RC) and related risk factors in the early and late postoperative periods in patients receiving general anesthesia with intermediate-acting muscle relaxants. METHODS: Two-hundred and eight American Society of Anesthesiologists class I and II patients, aged 18-70 years, who underwent general anesthesia with intermediate-acting muscle relaxants, were included. Heart rate, blood pressure, oxygen saturation, tympanic temperature were recorded for each patient who was transported to the recovery room, every 10 minutes by a trained nurse. To define the efficacy of residual muscle relaxants, neuromuscular monitoring was performed, and Train of Four (TOF) ratios < 90% were regarded as RC whereas ratios ≥ 90% were considered as adequate neuromuscular recovery in early and late recovery periods. Age, duration of anesthesia, repeated doses, reversal and types of intermediate-acting neuromuscular blockers were evaluated as risk factors for RC. Logistic Regression Analysis was performed to define the risk factors for RC in early and late periods. RESULTS: The RC rate was 10.6% in the early recovery period, and short duration of anesthesia, repeated doses and lack of reversal use were the risk factors for RC. However, RC rate was 2.9% in the late recovery period, and the only risk factor was repeated doses. CONCLUSION: Reversal use was shown to reduce residual effects of intermediate-acting muscle relaxants in early recovery period, whereas risk of RC in 30 min in PACU was shown to increase with repeated doses of muscle relaxants.

The incidence of residual neuromuscular blockade associated with single dose of intermediate-acting neuromuscular blocking drugs.

BACKGROUND: The goal of this study is to investigate the incidence and risk factors of residual paralysis associated with single-dose intermediate-acting muscle relaxants (atracurium, vecuronium, rocuronium) during early postoperative period. METHODS: Adult patients (ASA I and II) who received a single dose of vecuronium, atracurium or rocuronium during general anesthesia for elective surgical procedure were included in the study. Train-of-four (TOF) ratios under 0.9 were recorded as "postoperative residual neuromuscular block (PRNB)". Age, weight, gender, reversal, anesthesia duration, time for transfer to the recovery room after extubation were studied regarding with PRNB. RESULTS: 84 patients were included in this study. 29 patients were received vecuronium, 28 patients were received atracurium and 27 patients were received rocuronium. Neostigmine was used for reversal in 49 patients (58.3%) at the end of the surgery. PRNB incidence (TOF < 0.9) was 13.1%. Based on the regression analysis, the only risk factor affecting PRNB was found as gender. PRNB risk was increased in women (OR: 7.250, 95%, CI: 1.019-51.593). CONCLUSION: In patients who have general anesthesia longer than one hour, "gender" may affect residual paralysis incidence associated with single-dose intermediate-acting muscle relaxants use.