Adverse Events during Vitrectomy under Adequacy of Anesthesia—An Additional Report

Abstract

The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV.

Adequacy of Anesthesia and Pupillometry for Endoscopic Sinus Surgery

“…Although the anesthetic regimen of SPI-guided remifentanil infusion is usually based on the assumption that any SPI value > 50 or intraoperative delta SPI > 10 constitutes an indication of the acceleration of remifentanil infusion [38], we adopted a more liberal protocol (delta SPI >15 as compared with mean SPI value before the start of FESS, stage 2) to avoid potential miscalculations and hazardous uncontrolled hypotension and bradycardia [18,[39][40][41][42][43]. We have applied the same methodology in several recently published studies [44][45][46][47]. Furthermore, a stricter protocol could possibly have led to even more impressive intraoperative outcomes at the cost of excluding ASA III patients, limiting the application of these novel techniques, or imposing unnecessary risks of perioperative complications [47].…”

Adverse Events during Vitreoretinal Surgery under Adequacy of Anesthesia Guidance—Risk Factor Analysis

“…The mean demand for IRNA had no significant impact on the occurrence of PONV and OCR, despite the group allocation, although a significantly higher demand for intraoperative IRNA using FNT was recorded among patients in the M group as compared to the PBB group (Table 1). M group-patients who received PA using a single dose of 1 g of metamizole intravenously 30 min before arrival at operating room; P group-patients who received PA using a single dose of 1 g of acetaminophen intravenously 30 min before arrival at the operating room; PBB group-including patients who received PBB using a mixture of 3.5 mL each of 2% lignocaine and 0.5% bupivacaine with Hamilton's technique 1 min before induction of GA; T group-patients who received preventive topical analgesia by triple instillation of 2% proparacaine; PONV-postoperative nausea and vomiting; OCR-oculocardiac reflex; SD-standard deviation; IQR-interquartile range [11,12].…”

“…Informed consent was obtained from all patients recruited. This section builds upon our previous work [11,12,60,61].…”

“…The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Bioethical Committee of the Medical University of Silesia (protocol code KNW/0022/KB1/101/15 and date of approval 29 September 2015). The project was registered in the Clinical Trial Registry (SilesianMUKOAiIT2, NCT02973581) and received the same approval as previous studies [11,12,60,61]. Informed consent was obtained from all patients recruited.…”

“…In our previous studies, we investigated the influence of the AoA guidance on GA in patients undergoing pars plana vitrectomy (PPV) on the rate of incidence of postoperative intolerable pain perception (PIPP), hemodynamic stability [11], and the rate of incidence of OCR and PONV [12]. The current analysis aimed to identify risk factors for the occurrence of OCR or PONV when AoA guidance for GA alone or combined with different PA techniques was utilized.…”