Ocular risk management in patients undergoing general anesthesia: an analysis of 39,431 surgeries

OBJECTIVE: This study sought to describe and analyze ocular findings associated with nonocular surgery in patients who underwent general anesthesia. METHODS: The authors retrospectively collected a series of 39,431 surgeries using standardized data forms. RESULTS: Ocular findings were reported in 9 cases (2.3:10,000), which involved patients with a mean age of 58.9±19.5 years. These cases involved patients classified as ASA I (33%), ASA II (55%) or ASA III (11%). General anesthesia with propofol and remifentanil was used in 4 cases, balanced general anesthesia was used in 4 cases, and regional block was used in combination with balanced general anesthesia in one case. Five patients (55%) underwent surgery in the supine position, one patient (11%) underwent surgery in the lithotomy position, two patients (22%) underwent surgery in the prone position, and one patient (11%) underwent surgery in the lateral position. Ocular hyperemia was detected in most (77%) of the 9 cases with ocular findings; pain/burning of the eyes, visual impairment, eye discharge and photophobia were observed in 55%, 11%, 11% and 11%, respectively, of these 9 cases. No cases involved permanent ocular injury or vision loss. CONCLUSION: Ophthalmological findings after surgeries were uncommon, and most of the included patients were relatively healthy. Minor complications, such as dehydration or superficial ocular trauma, should be prevented by following systematic protocols that provide appropriate ocular occlusion with a lubricating ointment and protect the eye with an acrylic occluder. These procedures will refine the quality of anesthesia services and avoid discomfort among patients, surgeons and anesthesia staff. .

O impacto neuroendocrinológico do uso prolongado de morfina por vias espinal e oral no tratamento da dor crônica / Neuroendocrine and metabolic effect of the treatment of non-cancer pain patients with morphine used through oral or spinal route

Introdução. Foram avaliados prospectivamente com o questionário de qualidade de vida Treatment Outcomes in Pain Survey (TOPS) escala visual analógica (EVA) e a função hipotálamo-hipofisária de 57 doentes com dor não decorrente de doença oncológica; 20 doentes eram do sexo feminino (18 a 45 anos) e 37 do sexo masculino (18 a 60 anos), sendo 19 tratados com 60 ao 120mg/dia de morfina por via oral (grupo oral), 19 com 0,2 a 10 mg/dia de morfina por via espinal (grupo espinal) e 19 sem morfina (grupo controle). Resultados. Ocorreu alteração significativa da libido em ambos os sexos nos doentes tratados com morfina por ambas as vias de administração; 84,2% dos doentes do grupo controle não referiram alterações clínicas na esfera sexual. Comprometimento da potência sexual foi significativamente mais referida nos homens do grupo oral que nos do grupo controle, fogacho foi mais prevalente nas doentes do sexo feminino tratadas com morfina por ambas a as vias de administração e ocorreu alteração do ciclo menstrual em todas as doentes do sexo feminino tratadas com morfina por via espinal. As concentrações séricas de testosterona total inferiores a < 271 ng/dl foram significativamente mais prevalentes nos doentes dos grupos espinal (58,33%) e oral (70%) do que nos do grupo controle (16,7%)(p=0,012). A concentração sérica do DHEAS foi baixa nos doentes dos grupos espinal e oral. As respostas estimuladas do TSH após estímulo com TRH foram subnormais nos grupos espinal e oral (p=0,020). As concentrações basais e estimuladas de LH, FSH, as plasmáticas basais do ACTH, as plasmáticas do pico e basais do cortisol, a excreção urinária do cortisol, as concentrações basais do IGF-I e do pico do GH durante o teste de tolerância da insulina e concentração sérica dos hormônios tireoidianos. não diferiram estatisticamente entre os grupos. As concentrações séricas do colesterol total acima de 200mg/dl e concentrações elevadas do PCR foram significantemente mais frequentes nos doentes...

Abstract: The hypothalamic-pituitary function, the quality of life and the pain severity of 57 non-cancer pain patients treated or not with morphine through the oral or spinal route were prospective analyzed. Twenty were females (18 - 60 yr) and 37, males (18 - 45 yr). Nineteen were treated with 60 to 120mg/day of morphine sulfate trough the oral route (oral group), 19, with 0.2 to 10 mg/day of morphine infusioned into the intrathecal space through a implanted pump (spinal group), and 19, with non-opioid analgesics and adjuvants (control group). Results. Patients treated with morphine developed significant impairment of the libido and more men of the oral group developed reduction of sexual potency than of the control group, more women treated with morphine presented hot flushes than women of the control group, and all women of the spinal group had menstrual cycle dysfunction. More patients treated with morphine presented total serum testosterone levels <271 ng/dL than patients of the control group (p=0.012). Serum basal or stimulated LH and FSH levels, basal ACTH plasma levels, basal and peak cortisol plasma levels, basal serum IGF-I levels, GH serum peak during the insulin tolerance test, 24h free cortisol urinary excretion, serum concentration of thyroid hormones, serum fibrinogen, cholesterol fractions, triglycerides and Lpa levels were not statistically different among the patients included in any of the three study groups. More patients treated with morphine presented reduced DHEAS serum levels and subnormal TSH serum responses stimulated with TRH (p=0.020). More patients treated with morphine presented total cholesterol serum levels >200mg/dL and higher C-reactive protein levels (p=0.03) than those of the control group. The serum 25-OH-vitamin D levels were lower than 30ng/mL in 69% to 94% of the patients in patients belonging to all 3 study groups. More men of the spinal group presented total body BMD bellow normal than patients of the other...