View related articles View Crossmark data Citing articles: 1 View citing articles Southern African Journal of Anaesthesia and Analgesia is co-published by Medpharm Publications, NISC (Pty) Ltd and Informa UK Limited [trading as the Taylor & Francis Group].

Ptosis occurs when the muscles that raise the upper eyelid (levator and Muller's muscle) get damaged. There are lot of ptosis correction surgery reported in the journals of oculoplastic surgery and opthalmic surgery. Most of these surgeries are cosmetic correction. Rarely ptosis can be seen as a complication following orbitozygomatic complex injuries. Cause of traumatic ptosis most often is levator detachment from the superior tarsal plate. Lacerations of the lid may sever the levator tendon leading to scarring and secondary mechanical ptosis. Challenge in surgical management lies in identification of Levator aponeurosis, posterior to orbital septum and preaponeuratic fat. Once the levator muscle is freed from scar tissue it should be reapproximated to tarsal plate.

"Ball valve thrombus" which is a spherical free floating clot in left atrium is an often quoted, but uncommonly encountered complication in patients with severe mitral stenosis of rheumatic origin, who are in atrial fibrillation. We describe the case of a 31-year-old lady with rheumatic heart disease, severe mitral stenosis and moderately severe aortic stenosis who had undergone closed mitral valvotomy 13 years ago. The patient presented with an episode of non-exertional syncope and breathlessness on exertion of 6 months duration and was in normal sinus rhythm. Echocardiography facilitated ante-mortem diagnosis and prompt institution of surgery was life saving.

Background: Autonomic dysfunction (AD) is infrequently evaluated preoperatively despite having profound perioperative implications. The ANSiscope™ is a monitoring device that quantifies AD. This study aims to determine the potential of the device to predict hypotension following anesthetic induction, occurrence of arrhythmias, and inotrope requirement for patients undergoing off-pump coronary artery bypass surgery (OPCAB). Study Design: Prospective observational double-blinded study. Materials and Methodology: Seventy-five patients undergoing OPCAB had their autonomic function assessed by ANSiscope™. They were classified into four groups based on their AD and compared to perioperative adverse events. Results: Patients with diabetes had a higher ANSindex ( P = 0.0263). They had a greater decrease in systolic blood pressure ( P = 0.001) and mean arterial pressure ( P = 0.004) postinduction, had an increased incidence of arrhythmias ( P = 0.009), required higher inotropic support immediately ( P = 0.010) and at 24 h after surgery ( P = 0.018), and longer duration of postoperative ventilation ( P < 0.001). They also had a higher incidence of emergency conversion of OPCAB to on-pump surgery ( P = 0.009). Conclusions: An increased association between AD as quantified by the ANSiscope™ and perioperative adverse outcomes was observed. An increased rate of emergency conversion of OPCAB to on-pump surgery with higher dysfunction was noted. The authors opine that the threshold for conversion must be lower in patients deemed to be at a higher risk. Proper evaluation of the autonomic nervous system empowers the anesthesiologist to anticipate and adequately prepare for complications.

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