INTRODUCTIONSignificant changes have been introduced to the techniques and instruments used for cataract surgery over the past 20 years. Such changes include phacoemulsification without corneal suture and the development of foldable intraocular lenses, which allow smaller and self-sealing incisions (1) . Additionally, a wide range of anesthetic techniques has been developed for cataract surgery during that period, including general, ophthalmic regional, and topical anesthesia (2) . ABSTRACTPurpose: Ocular akinesia, the use of anticoagulants, and patient collaboration are some of the factors that must be taken into consideration when choosing the appropriate anesthesia for phacoemulsification cataract surgery. The satisfaction of patients with the use of topical anesthesia and conscious sedation for this procedure has not been enough described in Brazil. Conscious sedation allows patient walk and answer a voice command. To assess the satisfaction, pain, and perioperative hemodynamic alterations of patients subjected to phacoemulsification under conscious sedation and topical anesthesia supplemented with intracameral lidocaine. Methods: Prospective cohort non-controlled study that included patients treated by the same surgical team over a 70-day period. Sedation was performed with midazolam at a total dose of 3 mg and topical anesthesia with 0.5% proxymetacaine chlorhydrate and 2% lidocaine gel combined with 2% lidocaine by intracameral route. The intraoperative vital parameters, scores based on the Iowa Satisfaction with Anesthesia Scale (ISAS), and the pain visual analog scale (VAS) were recorded at several time points after surgery. Results: A total of 106 patients were enroled in study (73.6% female), the mean age was 65.9 years. The surgical procedures lasted 11.2 minutes on average. The hemodynamic parameters did not exhibit significant changes at any of the investigated time points. The average ISAS score was 2.67 immediately after surgery and 2.99 eight hours after the surgery; this increase was statistically significant (p<0.0001). More than two-thirds (68.9%) of the participants (73 patients) did not report any pain in the transoperative period, and 98.1% of patients denied the occurrence of pain after surgery. Conclusions:Patients that received topical anesthesia supplemented by intracameral lidocaine combined with sedation for phacoemulsification cataract surgery reported adequate level of satisfaction with the anesthetic choice. Furthermore, the patients exhibited hemodynamic parameter stability and pain control.
REVIEW ARTICLEmeans of food administration to brain injury patients as tool to reduce gastrointestinal symptoms. Of note, food intolerance may be associated with increased morbidity and increased hospital stay costs. (2,3) Considering the paucity of both national and international studies correlating SAH, ICH and gastric emptying (GE), the main objective of this paper is to compare and discuss physiological and pathophysiological related to SAH, ICH and gut motility. METHODSA literature search was conducted to analyze the pattern of gut motility following acute brain injury with ICH. Articles discussing possible therapeutic approaches for ICH-related gut complications were also evaluated. The literature search included national and international health sciences journals, and we searched for articles related to the brain-gastrointestinal tract functional axis and its behavior either in experimental animal models of brain injury or acute brain injury patients. Using the inclusion criteria, a web based search was conducted on the following electronic libraries: Scientific Electronic Library Online (Scielo) © , Periódicos/Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) © , PubMed/Medline© and Google Scholar Beta © .Twenty-five articles published between 1982 and 2010 were selected. Of those, eleven focused on the influence of ICH on gut motility (GM), ten discussed means of nutrition of administration in moderate to severe head trauma (HT) (Glasgow coma scale < 8), and finally, four articles discussed the main metabolic changes in head trauma subjects, with an emphasis on nutritional support. Influence of intracranial hypertension on gut motilityEleven articles about ICH influence about gut motility were analyzed. Five (45.4%) were related to gastric and intestinal emptying, four (36.3%) focused on pressure changes throughout the gastrointestinal tract (GIT) (two studied the amplitude and frequency of food propellant contractions, and the other two analyzed the inferior esophageal sphincter behavior under ICH conditions), and two (18.1%) studies evaluated GIT electrical activity, studying the migratory myoelectric complex by means of body surface electrodes or electrogastrogram. Of all of the articles, two (18.8%) reported that HIC variation is directly proportional to gastric contraction intensity, based on a GE analysis of the amplitude and frequency of contractions in anesthetized rats with intra-cerebral cannulation-induced ICH. The remaining nine (81.8%) articles found that increased ICP is related to slower GIT transit, and this food bolus transit delay is associated with intolerance to enteral nutrition. Pharmacological intervention to accelerate the GIT was evaluated in one of the analyzed articles. Another study was designed to evaluate the association between ICP changes in thirty-seven intracranial tumor patients who performed Valsalva's maneuver during evacuation. All patients performed the maneuver, independent of constipation, and no increased ICP decompensation was observed. Additi...
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