Management of cataract surgery in Lowe syndrome.

AIM: To evaluate the ophthalmic and anesthesiologic management of cataract surgery in children with Lowe syndrome receiving lens removal, the development and management of secondary glaucoma. METHODS: This retrospective case series included 12 eyes of 6 children with genetically verified Lowe syndrome receiving cataract removal. Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intra- and postoperative complications were noted as well as clinical examinations such as visual acuity and funduscopy. RESULTS: All children received simultaneous bilateral cataract surgery at the mean age of 8.98±3.58wk. Lensectomy combined with posterior capsulotomy and anterior vitrectomy was performed in all children. The mean time for cataract surgery per eye was 35.83±8.86min, whereas the total time of surgery was 153.33±22.11min. The mean extubation time and duration at recovery room was 42.33±22.60min and 130.00±64.37min, respectively. During surgery, a decrease of oxygen saturation below 93% was found in only one child. During the postoperative follow-up, nystagmus (6 children) and strabismus (5 children) was commonly found in contrast to no case of visual axis opacification. Secondary glaucoma developed in five eyes of three children, which was treated with topical eye drops in only one child. A trabeculectomy was performed in both eyes of one child, whereas removal of syechia and an iridectomy in one eye of one child. CONCLUSION: Bilateral simultaneous cataract surgery under general anesthesia is a safe surgical procedure in Lowe syndrome children. The glaucoma screening with intraocular pressure measurements is crucial in the postoperative management of Lowe syndrome patients to avoid additional visual impairment.

Simultaneous Bilateral Pediatric and Juvenile Cataract Surgery Under General Anesthesia: Outcomes and Safety.

PURPOSE: To evaluate the surgical approach, outcome, and safety of bilateral simultaneous cataract surgery (BS-Cat) compared with unilateral cataract surgery (US-Cat) and bilateral 2-timed cataract surgery (BT-Cat) in children. DESIGN: Retrospective, interventional case series. METHODS: Setting: Department of Ophthalmology, Medical University, Vienna, Austria. PARTICIPANTS: Children aged 0-18 years who received cataract extraction owing to a unilateral or bilateral cataract between January 2003 and December 2018 were included. Main Outcomes and Measures: Information regarding the type and duration of surgery and total anesthesia time were recorded. Additionally, intraoperative and postoperative complications including retreatments were evaluated. RESULTS: A total of 220 eyes of 147 patients were included in this analysis (US-Cat: n = 74 patients; BS-Cat: n = 63 patients; BT-Cat: n = 10 patients). The mean age at surgery was 15.94 ± 27.10 months in the US-Cat group, 33.47 ± 58.20 months in the BS-Cat group, and 41.91 ± 55.09 months in the BT-Cat group. The main surgical approach was lensectomy combined with anterior vitrectomy ± IOL implantation (US-Cat: 98.65%; BS-Cat: 95.24%; BT-Cat: 100%; P = .08). Initial intraocular lens implantation was not commonly performed in all groups (US-Cat: 27.03%; BS-Cat: 23.02%; BT-Cat: 50.00%). The mean anesthesia time was shortest in the US-Cat (91.62 ± 26.12 min), followed by the BS-Cat (123.81 ± 30.11 min) and BT-Cat groups (186.00 ± 42.34 min; P < .001), contrary to the duration of surgery (US-Cat: 37.56 ± 15.69 min; BS-Cat: 32.33 ± 17.31 min; BT-Cat: 37.50 ± 18.67; P = .087). An accidental oxygen decrease below 93% was rare in all groups (US-Cat: 6.76%; BS-Cat: 17.46%; BT-Cat: 10.00%). Intraoperative surgical complications occurred rarely (P = .95) and involved mainly the iris. The number of postoperative complications (P = .17) and interventions (P = .10) was similar in all groups. Visual axis obscuration (US-Cat: 28.38%; BS-Cat: 23.81%; BT-Cat: 20.00%; P = .67) and glaucoma (US-Cat: 6.76%; BS-Cat: 15.87%; BT-Cat: 15.00%; P = .20) showed no difference between the groups. However, nystagmus was more pronounced in the BS-Cat group (US-Cat: 12.16%; BS-Cat: 49.21%; BT-Cat: 20.00%; P < .001), whereas strabismus was more pronounced in the US-Cat group (US-Cat: 68.92%; BS-Cat: 33.33%; BT-Cat: 40.00%; P < .001). CONCLUSION: Simultaneous removal of bilateral cataract in children showed no statistically significant differences regarding intraoperative and postoperative complications when compared to unilateral and 2-timed bilateral cataract surgery. Anesthesia time was longer in simultaneous bilateral than in unilateral cataract surgery, but only by the surgery time of the second eye. However, prolonged anesthesia time was not accompanied by a decrease of oxygen saturation.

Risk of inferior vena cava compression syndrome during fetal MRI in the supine position - a retrospective analysis.

OBJECTIVES: Inferior vena cava compression syndrome (VCCS) is a serious complication of supine fetal magnetic resonance imaging (MRI) examinations, particularly during late gestation. This morphologic study correlated the occurrence of VCCS with the grade of inferior vena cava (IVC) compression. MATERIALS AND METHODS: There were 56 fetal MRI in the supine position [median gestational weeks (GW) 27+4] and 16 fetal MRI in the lateral position (median GW 30+6) retrospectively analyzed. The grade of maternal IVC compression was determined by the maximal anterior-posterior diameter (DAP) at the level of L4/L5. Fetal head position and right-sided uterus volume were analyzed. Clinical VCCS-related symptoms during fetal MRI were assessed. RESULTS: A noncompressed IVC was present in 1.8% (n=1) and a DAP of 5 to <10 mm in 33.3% (n=19) and 1 to <5 mm in 64.9% (n=36). The DAP was independent of fetal head position (P=0.99) and showed no significant correlation with gestational age (r=0.33). IVC compression increased with right-sided uterus volume (r=-0.328; P=0.014). There was a significant difference in DAP in the lateral position compared with the supine position (P<0.001). Clinical assessment revealed no symptoms of VCCS in any woman. CONCLUSIONS: The presented data support the concept of physiologic compensation for significantly reduced venous backflow in the supine position during the second and third trimesters of pregnancy.

Educational or organizational approach: which is more effective in changing blood-sampling habits?

UNLABELLED: Diagnostic blood loss is a recognized issue during the delivery of intensive care services. We designed this study to compare the effects of educational versus organizational approaches to reduce daily diagnostic blood loss in intensive care patients. First, as an educational approach, physicians on two wards were repeatedly informed about the importance of diagnostic blood loss and that 1.0-1.5 mL is sufficient for blood gas analysis. Second, as an organizational approach, 3-mL syringes were replaced by 2-mL syringes. Measurements after both periods were compared with a control group. The amount of drawn/discarded blood of 320 samples was measured in each group after the 2 interventions. Compared with the control group, the educational program reduced the amount of drawn/discarded blood in one ward, but not the other. After the organizational change, the amount of drawn/discarded blood was reduced in both wards. Additionally, because of the smaller costs of 2-mL syringes, implementation of 2-mL syringes saved US dollars 30800/yr in our hospital. In conclusion, our study shows that an educational program seems less effective in influencing physician behavior than organizational changes. Therefore, organizational changes should be favored over educational approaches whenever possible. IMPLICATIONS: Organizational change is more effective than educational programs to reduce diagnostic blood loss. Organizational implementation of smaller syringes reduces the amount of discarded blood and can save money.

Preoperative orthostatic dysfunction is associated with an increased incidence of postoperative nausea and vomiting.

BACKGROUND: Postoperative nausea and vomiting (PONV) occurs frequently after gynecologic surgery. Because hemodynamic condition seems to be influential, women presenting with preoperative orthostatic dysregulation may have an increased risk for PONV. The aim of the present study was to assess the relationship between preoperative orthostatic dysregulation and the incidence of PONV. METHODS: In a prospective observer-blinded clinical trial, 200 women who were scheduled for elective gynecologic surgery underwent an orthostatic test on the day before surgery. Based on the orthostatic test results, women were stratified into orthostatic dysregulation (OR; systolic blood pressure decrease > 20 mmHg on standing up) and nonorthostatic dysregulation (NOR; systolic blood pressure decrease < 20 mmHg) groups. RESULTS: Forty-nine women were stratified to the OR group and 151 to the NOR group. Frequencies of PONV and vomiting during the study period were higher in the OR group compared with the NOR group (77.6% vs. 31.1% and 55.1 vs. 18.5%, respectively; all P < 0.001). Women with hypotension in their history showed a significantly higher frequency of PONV within 24 h (P < 0.05). CONCLUSION: Women presenting with orthostatic dysregulation and arterial hypotension in their history exhibit an increased risk of PONV.

The effects of systolic arterial blood pressure variations on postoperative nausea and vomiting.

UNLABELLED: In this clinical study, we tested the hypothesis that a marked systolic blood pressure decrease >35% (DeltaSBP >35%) from preanesthetic baseline during the induction and maintenance of anesthesia is associated with more postoperative nausea and vomiting (PONV). In 300 ASA physical status I and II women undergoing elective gynecological surgery with general anesthesia, the maximum DeltaSBP during the induction as well as maintenance of general anesthesia were calculated. Observers blinded to hemodynamic variables assessed the incidence of PONV. The overall incidence of nausea (visual analog scale >4) and vomiting within the immediate observation period (0-2 h) was 39% and 25%, respectively. Frequency of nausea and vomiting in the late observation period was 21% and 9%, respectively. Women with a DeltaSBP >35% during the induction of anesthesia suffered from a more frequent incidence of PONV within the immediate (57% versus 35% and 41% versus 22%, respectively; P < 0.01) and within the late observation period (33% versus 18% and 19% versus 7%, respectively; P < or = 0.01). In women with a DeltaSBP >35% during maintenance of anesthesia, a more frequent incidence of nausea within the immediate observation period (53% versus 36%; P < 0.05) was found. We conclude that a maximum DeltaSBP >35% during the anesthetic induction is associated with an increased incidence of PONV after gynecological surgery during general anesthesia. IMPLICATIONS: A prospective clinical investigation revealed that a marked systolic blood pressure decrease >35% (DeltaSBP >35%) during the induction of general anesthesia is associated with an increased incidence of postoperative nausea and vomiting (PONV). The association between a DeltaSBP >35% during maintenance of general anesthesia and PONV is less pronounced.