Variation of blood pressure during topical phacoemulsification.

BACKGROUND: The changes of blood pressure in patients undergoing cataract procedure are not well studied. The blood pressures of cataract patients often become uncontrolled intraoperatively causing the procedure to be postponed. Intraoperative rise in blood pressure has been associated with ocular complications such as suprachoroidal haemorrhage and can be fatal from stroke or even myocardial infarction. We attempt to study the changes in blood pressure of patients undergoing cataract surgery. AIM: Prospective study on the variation of blood pressure pre- and intra-operatively. METHOD: The blood pressure readings of patients going for cataract procedures were measured in five stages during the pre-assessment clinic, on arrival at the day surgery, at the anaesthetic room, on the operating table intraoperatively; and postoperatively. The readings were compared to their age, sex, past medical history, and use of antihypertensive medication. RESULTS: The rise in systolic blood pressures between intraoperative readings and those at the preassessment and anaesthetic room was highly statistically significant.Being older (>65 years of age), taking more than two antihypertensive drugs, being hypertensive, or having a family history of hypertension does not appear to increase the risk. CONCLUSION: Our study showed that there is a significant rise in systolic blood pressures especially in females during topical phacoemulsification. Further studies are needed on the factors that determine this increase and the changes in blood pressures during different stages of the procedure.

Should epidural diamorphine be withheld after caesarean section from women who suffer severe pruritus following intrathecal fentanyl?

Pruritus following neuraxial opioids in 37 women undergoing caesarean section under combined epidural-spinal anaesthesia was investigated. All women received intrathecal fentanyl for intra-operative analgesia followed by epidural diamorphine for postoperative analgesia, when pain returned. Pruritus was assessed using a verbal rating scale at the end of surgery and again 24-36 h postoperatively. There was no relationship between pruritus experienced after intrathecal fentanyl and that experienced after epidural diamorphine. We conclude that there is no reason to withhold epidural diamorphine from women who have previously experienced severe itching after intrathecal fentanyl.