Factors Prompting Sneezing in Intravenously Sedated Patients Receiving Local Anesthetic Injections to the Eyelids

Morley, Ana M. S.; Jazayeri, Fiona; Ali, Syed; Malhotra, Raman

doi:10.1016/j.ophtha.2009.09.007

Cited by 14 publications

(9 citation statements)

References 23 publications

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“…These authors further concluded that a history of photic sneezing, bilateral or upper eyelid infiltration, deep sedation, and concurrent administration of midazolam increased the risk whereas adjunctive opioid use reduced it. [12]…”

Section: Discussionmentioning

confidence: 99%

A comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block

Hakim

Alsaeid

2019

Anesth Essays Res

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Background: The photic sneeze reflex (autosomal dominant) is a condition that causes sneezing in response to numerous stimuli, such as looking at bright lights or periocular (surrounding the eyeball) injection. Unexpected or sudden sneezing during injection can be a dangerous side effect in periocular injection, in which abrupt head movement may cause globe injury. Aims: We intended to evaluate the efficacy of adding fentanyl, dexmedetomidine, and antihistamines on the incidence of the sneeze reflex associated with propofol sedation during periocular local anesthesia injections. Settings and Design: Our study was a randomized, prospective, double-blinded and controlled clinical study. Patients and Methods: This study was conducted in Ain Shams and Fayoum university hospitals at the ophthalmic surgery department. After obtaining approval from our universities ethical committee and written informed valid consents from the patients, 90 patients were included in this study. The study population included patients of both sex, ASA grade 1 and 2, in the age ranging from 18-65 years. Patients were scheduled for cataract extraction surgeries and received peribulbar block. Then patients were randomly divided into three groups (30 patients each) using a computer- generated table of random numbers. Patients were preoxygenated with supplemental oxygen by nasal cannula, all 90 patients received intravenous propofol 1mg.kg- 1 bolus for sedation and were randomized to receive adjunctive drug 2 to 4 minutes prior to propofol injection: 30 patients received intravenous fentanyl 1 μmg.kg -1 (Group F), 30 patients received dexmedetomidine 1μmg.kg -1 (Group D), and 30 patients received antihistamine (pheniramine 22.75 mg) (Group H). The same local anesthetic admixture, consisting of 5 mL 2% lidocaine with 90 IU hyaluronidase, combined with 5 mL 0.5% plain bupivacaine in a 10-mL syringe at room temperature was administered to all patients using peribulbar block technique. A masked observer (surgeon or anesthesia assistant) recorded whether the patient had a sneezing event. Continuous cardiorespiratory monitoring was performed intraoperatively. Intraoperative and postoperative medication side effects were recorded including bradycardia (HR <55 beats/min), hypotension (MAP <50 mmHg sustained for >10 min), oxygen desaturation (SpO2<90%), nausea, vomiting and prolonged sedation using Ramsay Sedation Score (RSS). Statistical Analysis Used: Student's t -test and Chi-square test were used for analysis. Results: The demographic data of the three study groups revealed non-significant differences between the three study groups as regards age, sex distribution, and the duration of surgery. No patient was excluded after inclusion to the study. All patients were able to complete the entire study and their data...

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Section: Discussionmentioning

confidence: 99%

A comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block

Hakim

Alsaeid

2019

Anesth Essays Res

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“…Intravenous medications have been the mainstay of sedation to alleviate patients’ anxiety during periocular anesthetic injections. Drugs like propofol, ketamine, alfentanil and midazolam have been used alone or in combination, 2–6 with propofol usually claiming the lion’s share 3,6 . Despite the popularity of propofol, questions have always been raised about its potential safety particularly the risk of sneezing which could theoretically lead to catastrophic ocular complications 3–6 .…”

Section: Discussionmentioning

confidence: 99%

“…An ideal sedative should be introduced painlessly, should have a rapid onset of action, minimal side effects, and speedy recovery and should not lead to intraoperative behavioral disturbances 1 . The most commonly used sedatives in oculoplastic procedures nowadays are propofol, midazolam, and alfentanil alone or in combination 2–8 …”

Section: Introductionmentioning

confidence: 99%

Sevoflurane versus propofol sedation during periocular anesthetic injections in oculoplastic procedures: An open-label randomized comparison

Tawfik

Mostafa²

2015

Saudi Journal of Ophthalmology

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“…We have discussed with our anesthetic colleagues efforts to avoid the sneezing reflex which can occur with periocular anesthetic injection, while the patient is sedated with the use of alfentanil or fentanyl. 11 – 13 Hudson masks deliver oxygen to patients requiring sedation to provide a seal around the airway. A clear plastic drape taped to the oxygen mask is tucked behind the patient’s shoulders for further protection.…”

Section: Challenges In the Delivery Of Patient Carementioning

confidence: 99%

Oculoplastic, Orbital, and Lacrimal Care in the Coronavirus Disease 2019 Pandemic: A Shared Experience From Melbourne

O’Rourke¹,

Hardy²,

Au³

et al. 2020

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Factors Prompting Sneezing in Intravenously Sedated Patients Receiving Local Anesthetic Injections to the Eyelids

Cited by 14 publications

References 23 publications

A comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block

A comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block

Sevoflurane versus propofol sedation during periocular anesthetic injections in oculoplastic procedures: An open-label randomized comparison

Oculoplastic, Orbital, and Lacrimal Care in the Coronavirus Disease 2019 Pandemic: A Shared Experience From Melbourne

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