[Anesthesia for vitreoretinal surgery using a retrobulbar catheter technique]. / Anestesia en cirugía vitreorretiniana utilizando un catéter retrobulbar.

OBJECTIVE: To evaluate peroperative pain management using a flexible spinal anesthesia catheter introduced into the retrobulbar space which allows injections of local anesthetics for vitreoretinal surgery. METHODS: Twenty-five patients who underwent vitreoretinal surgery receiving retrobulbar anesthesia with 3.5 ml ropivacaine 0.75%. After injection, a catheter with spinal needle 22G x 1 1/2 (40 x 0.7 mm) was introduced to the retrobulbar muscle cone. The needle was withdrawn and the catheter was fixed. When the patient started to feel pain (grade 3 or higher), 2 ml ropivacaine 0.75% was administrated through the catheter during surgery or 2 ml ropivacaine 0.2% in the postoperative period. The catheter was removed 24- 48h later. RESULTS: During surgery, 1 patient (4%) received a re-injection of 2 ml ropivacaine 0.75% because of pain. Three patients (12%) experienced pain of grade 3 or higher in the postoperative period and needed re-injection of 2 ml ropivacaine 0.2%. Re-injections were an effective method to achieve analgesia. Adverse effects were not noticed. CONCLUSIONS: The retrobulbar catheter technique is a procedure which allows multiple re-injections of local anesthetics; it provides adequate analgesia during surgery and rapid, effective and safe postoperative pain management.

Anestesia en cirugía vitreorretiniana utilizando un catéter retrobulbar / Anesthesia for vitreoretinal surgety using a retrobulbar catheter technique

Objetivos: Evaluar el manejo del dolor peroperatorio en la cirugía vitreorretiniana, utilizando un cateter retrobulbar que permita reinyecciones de anestésicos locales. Métodos: Fueron incluidos en el estudio 25 pacientes, sometidos a cirugía vitreorretiniana, utilizando un catéter flexible introducido en el espacio intraconal, a través de una aguja espinal 22 G 1 1/2 de 40x0,7 mm, con la que depositamos previamente 3,5 ml de ropivacaína 0,75% retrobulbares, dejando posteriormente el catéter fijado a piel. Ante la presencia de dolor (grado 3 o superior) se reinyectaron en el postoperatorio 2 ml de ropivacaína 0,2%, y 2 ml al 0,75% si el dolor acontecía intraoperatoriamente. El catéter se mantuvo entre 24 y 48 horas. Resultados: Un paciente (4%) manifestó moderado dolor intraoperatorio, que cedió tras la administración de 2 ml de ropivacaína 0,75% a través del catéter, y no ocasionó interrupción de la cirugía. Tres pacientes (12%) precisaron una reinyección postoperatoria de 2 ml de ropivacaína 0,2% por dolor. Las reinyecciones aliviaron el dolor de forma inmediata (menos de 3 min). No se precisaron segundas reinyecciones, ni se detectaron complicaciones derivadas de la técnica. Conclusiones: La cateterización del espacio retrobulbar permite la administración fraccionada de anestésicos locales, aportando a la cirugía vitreorretiniana un adecuado soporte anestésico, así como un control del dolor postoperatorio de forma inmediata, eficaz y segura (AU)

Objective: To evaluate peroperative pain management using a flexible spinal anesthesia catheter introduced into the retrobulbar space which allows injections of local anesthetics for vitreoretinal surgery. Methods: Twenty-five patients who underwent vitreoretinal surgery receiving retrobulbar anesthesia with 3.5 ml ropivacaine 0.75%. After injection, a catheter with spinal needle 22G x 1 1/2 (40 x 0.7 mm) was introduced to the retrobulbar muscle cone. The needle was withdrawn and the catheter was fixed. When the patient started to feel pain (grade 3 or higher), 2 ml ropivacaine 0.75% was administrated through the catheter during surgery or 2 ml ropivacaine 0.2% in the postoperative period. The catheter was removed 24-48h later. Results: During surgery, 1 patient (4%) received a re-injection of 2 ml ropivacaine 0.75% because of pain. Three patients (12%) experienced pain of grade 3 or higher in the postoperative period and needed re-injection of 2 ml ropivacaine 0.2%. Re-injections were an effective method to achieve analgesia. Adverse effects were not noticed. Conclusions: The retrobulbar catheter technique is a procedure which allows multiple re-injections of local anesthetics; it provides adequate analgesia during surgery and rapid, effective and safe postoperative pain management (AU)

[Mucocele from concha bullosa with invasion of the orbit]. / Mucocele de concha bullosa con afectación orbitaria.

We present a case of a 44-year-old man that came to the clinic with exophthalmus and frontal headaches. TC and MRI showed a fronto-sphenoidal mass with extension to the cribiform plate involving the orbit and pushing the eyeball forward. The mass was completely excised through intranasal endoscopic surgery and it was found out to be a mucocele from concha bullosa.

Mucocele de concha bullosa con afectación orbitaria / Mucocele from concha bullosa with invasion of the orbit

Se presenta el caso de un varón de 44 años que consultó por exoftalmos y cefalea frontal. La tomografía computarizada y la resonancia magnética demostraron una masa etmoidoesfenoidal con expansión hacia la lámina cribosa que comprometía el volumen orbitario y empujaba el globo ocular hacia delante. La masa fue eliminada totalmente por cirugía endoscópica intranasal, descubriendo que se trataba de un mucocele originado en la concha bullosa (AU)

We present a case of a 44-year-old man that came to the clinic with exophthalmus and frontal headaches. TC and MRI showed a fronto-sphenoidal mass with extension to the cribiform plate involving the orbit and pushing the eyeball forward. The mass was completely excised through intranasal endoscopic surgery and it was found out to be a mucocele from concha bullosa (AU)

[Evaluation of the work time used in outpatient ophthalmology techniques]. / Estimación de tiempos médicos para técnicas oftalmológicas ambulatorias.

PURPOSE: To determine the work time used for out-patients seen in the ophthalmology out-patient clinic according to treatment for each diagnosis and examination guidelines. Another objective was to discover the diagnostic related outpatient demand as well as the time spent on each technique. METHOD: We have designed a computer database system that includes examinations, treatments and medical services. Their duration was measured in a random sample of 127 ophthalmology outpatients in the General Hospital of Castellon. Sixty five of the patients had come to their first visit and 62 to the follow-up visits. RESULTS: A new patient spends a mean of 42 minutes and a follow-up patient spends a mean of 27 minutes. The most frequent diagnoses are retinal diseases (30%), cataract (18.6%), glaucoma (11.8%) and ocular motility disorders (11.8%). We present the mean times used by the physician in the ophthalmic techniques used in outpatients. CONCLUSIONS: We have modified the standard times of 30 minutes for the first visit and 15 minutes for the follow-up visit. Data on the work time used for all the ophthalmics techniques in our outpatient clinic are presented. This ophthalmology survey can be used for health care managers to establish the <> and health care plan administration to adapt the resources to the demand.

Estimación de tiempos médicos para técnicas oftalmológicas ambulatorias / Evaluation of the work time used in outpatient ophthalmology techniques

Objetivo: Determinar el tiempo de trabajo consumido en pacientes ambulatorios en la consulta externa de Oftalmología, según protocolos exploratorios y de tratamiento por diagnóstico. Otros objetivos han sido, conocer la demanda ambulatoria por diagnósticos así como el tiempo requerido en cada técnica exploratoria. Método: Hemos diseñado un sistema de información donde se recogen todas las exploraciones, tratamientos y actos médicos. Se ha medido la duración de los mismos en una muestra aleatoria de 127 pacientes de Consultas Externas de Oftalmología del Hospital General de Castellón. Sesenta y cinco pacientes eran primeras visitas y 62 eran revisiones. Resultados: Un paciente de primera visita consume una media de 42 minutos y una revisión una media de 27 minutos, siendo las patologías más frecuentes las enfermedades retinianas (30 per cent), la catarata (18,6 per cent), el glaucoma (11,8 per cent) y las alteraciones oculomotoras (11,8 per cent). Presentamos los tiempos médicos medios consumidos por las técnicas oftalmológicas en pacientes ambulatorios. Conclusión: Modificamos los tiempos estandarizados de 30 minutos la primera visita y 15 minutos la segunda visita. Presentamos los tiempos médicos de todas las técnicas que disponemos en Consultas Externas. Ofrecemos datos a los gestores para establecer los 'Ambulatory Visit Group' (Grupos Relacionados con el Diagnóstico Ambulatorios) y para adecuar los recursos a la demanda (AU)