RESUMO
PURPOSE: To compare the level of sedation of oral administration of diazepam or midazolam associated or not with clonidine and their effects on upper eyelid margin position, heart rate, arterial pressure, and oxygen saturation. METHODS: Seventy consecutive healthy patients American Society of Anesthesiologists (ASA) grade I-II scheduled for lower eyelid blepharoplasty were randomized into 4 groups according to the oral sedative agent used (group 1, diazepam 10 mg; group 2, diazepam 10 mg plus clonidine 0.15 mg; group 3, midazolam 15 mg; group 4, midazolam plus clonidine 0.15 mg). For all patients, the midpupil-to-upper eyelid margin distance, the heart rate, systolic and diastolic blood pressure, and oxygen saturation were recorded before and 1 hour after the administration of oral medication. The level of sedation at the time of surgery was measured with the Michigan University scale. RESULTS: The depth of sedation was significantly more pronounced with midazolam (median score = 2) than with diazepam (median score = 1). Clonidine slightly increased the level of sedation of both diazepam and midazolam. The diastolic arterial blood pressure drop with midazolam associated or not with clonidine was significantly greater than with diazepam. The mean upper eyelid margin position shift (-1.42 mm) verified when clonidine was associated with midazolam was also significantly greater than with diazepam. DISCUSSION: Oral sedation with diazepam or midazolam associated or not with clonidine is safe for ASA grade I-II patients. The systemic effects of diazepam and midazolam were small and very similar. The sedation induced by midazolam was clearly greater than that induced by diazepam. However, this higher level of sedation was accompanied by a more important shift in upper eyelid margin position.
Assuntos
Analgésicos/administração & dosagem , Anestesia Local , Blefaroplastia , Clonidina/administração & dosagem , Diazepam/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Midazolam/administração & dosagem , Administração Oral , Procedimentos Cirúrgicos Ambulatórios , Pressão Sanguínea/efeitos dos fármacos , Sedação Consciente , Combinação de Medicamentos , Pálpebras/cirurgia , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/efeitos dos fármacos , Medicação Pré-AnestésicaRESUMO
We report the case of an 11-year-old girl with sickle cell disease who presented to the emergency room after being hit by a mud pie in the left frontal region. Examination evidenced left eye proptosis, eyelid swelling, reduced visual acuity and afferent pupillary defect, without any inflammatory signs such as fever, hyperemia or tenderness. Computed tomography of the orbits showed a large superomedial subperiosteal hematoma in the left orbit. The patient was treated with canthotomy, cantholysis and surgical draining of the hematoma. Two days after drainage she persisted with a subperiosteal hematoma and low visual acuity. A wide exploration of the orbital roof through a lid crease approach disclosed a thickened superior orbital rim with multiple bone defects along the roof and with continuous bleeding. Hemostasis was accomplished with bone wax. Orbital compression was resolved and the patient recovered her previous normal visual acuity.
Assuntos
Anemia Falciforme/complicações , Traumatismos Craniocerebrais/complicações , Hematoma/etiologia , Síndromes de Compressão Nervosa/etiologia , Doenças Orbitárias/etiologia , Periósteo/lesões , Criança , Descompressão Cirúrgica , Drenagem , Combinação de Medicamentos , Feminino , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hemostasia Cirúrgica , Hemostáticos/uso terapêutico , Humanos , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/cirurgia , Doenças Orbitárias/diagnóstico por imagem , Doenças Orbitárias/cirurgia , Palmitatos/uso terapêutico , Radiografia , Acuidade Visual/fisiologia , Ceras/uso terapêuticoRESUMO
We report the case of an 11-year-old girl with sickle cell disease who presented to the emergency room after being hit by a mud pie in the left frontal region. Examination evidenced left eye proptosis, eyelid swelling, reduced visual acuity and afferent pupillary defect, without any inflammatory signs such as fever, hyperemia or tenderness. Computed tomography of the orbits showed a large superomedial subperiosteal hematoma in the left orbit. The patient was treated with canthotomy, cantholysis and surgical draining of the hematoma. Two days after drainage she persisted with a subperiosteal hematoma and low visual acuity. A wide exploration of the orbital roof through a lid crease approach disclosed a thickened superior orbital rim with multiple bone defects along the roof and with continuous bleeding. Hemostasis was accomplished with bone wax. Orbital compression was resolved and the patient recovered her previous normal visual acuity.
Relatamos o caso de uma menina de 11 anos com doença falciforme, trazida à sala de emergência após ser atingida por um bloco de barro na região frontal esquerda. Apresentava ao exame proptose do olho esquerdo, edema palpebral, diminuição da acuidade visual e defeito pupilar aferente, sem quaisquer sinais inflamatórios como febre, hiperemia ou aumento de sensibilidade. A tomografia computadorizada de órbitas demonstrou um extenso hematoma subperiósteo superomedial na órbita esquerda. A paciente foi tratada com cantotomia, cantólise e drenagem cirúrgica do hematoma. Dois dias após a drenagem, ela permaneceu com um hematoma subperiósteo e a acuidade visual diminuída. Uma ampla exploração através de incisão no sulco palpebral superior revelou um rebordo orbitário superior espessado, e múltiplos defeitos ósseos ao longo do teto da órbita com sangramento persistente. Foi realizada hemostasia com cera óssea. A compressão orbitária foi resolvida, e a paciente recuperou a acuidade visual normal prévia.
Assuntos
Criança , Feminino , Humanos , Anemia Falciforme/complicações , Traumatismos Craniocerebrais/complicações , Hematoma/etiologia , Síndromes de Compressão Nervosa/etiologia , Doenças Orbitárias/etiologia , Periósteo/lesões , Descompressão Cirúrgica , Drenagem , Combinação de Medicamentos , Hemostasia Cirúrgica , Hematoma , Hematoma/cirurgia , Hemostáticos/uso terapêutico , Síndromes de Compressão Nervosa , Síndromes de Compressão Nervosa/cirurgia , Doenças Orbitárias , Doenças Orbitárias/cirurgia , Palmitatos/uso terapêutico , Acuidade Visual/fisiologia , Ceras/uso terapêuticoRESUMO
A 3-year-old boy was examined for a large nodular fasciitis in the upper eyelid. The lesion was confined to the preseptal plane of the upper eyelid, provoking mechanical ptosis. Excision by an eyelid crease approach was sufficient to restore normal eyelid position.
Assuntos
Doenças Palpebrais/diagnóstico , Fasciite/diagnóstico , Blefaroptose/diagnóstico , Blefaroptose/etiologia , Pré-Escolar , Diagnóstico Diferencial , Doenças Palpebrais/complicações , Doenças Palpebrais/cirurgia , Fasciite/complicações , Fasciite/cirurgia , Humanos , Masculino , Tomografia Computadorizada por Raios XRESUMO
A 28-year-old woman presented with progressive proptosis of the left eye. She had a history of familial thrombocytopenia and Hashimoto thyroiditis. CT of the orbits demonstrated a bilateral diffuse intraconal and extraconal infiltration. Biopsy from the left intraconal area revealed the typical histopathology of xanthogranuloma with a mixture of foamy histiocytes, Touton giant cells, and eosinophils. Systemic examination revealed a mediastinal and retroperitoneal infiltration with a focal lesion in the left kidney. A biopsy of the retroperitoneal area showed histopathology identical to that of the orbital lesion. A review of the literature indicated that the association between non-Langerhans histocytoses and immunologic dysfunctions is not uncommon. We hypothesize that Erdheim-Chester disease may be linked to an abnormal interaction between T-lymphocytes and macrophages similarly to the macrophage activation syndromes.