RESUMO

Abstract Objective Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. Methods This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. Results There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p= 0.0046). There were no differences in Hess area ratio by age group. Conclusion Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures. Level of evidence 4.

RESUMO

OBJECTIVE: Pediatric orbital blowout fractures can include pathologies that seem mild but require urgent release; serious sequelae can occur with standby surgery or conservative treatment. We sought to validate an algorithm for the treatment of pediatric orbital blowout fractures. METHODS: This retrospective cohort study included 61 pediatric patients, aged 18 years or younger, treated for pure orbital blowout fractures according to the algorithm from April 1, 2000, to August 31, 2020, at the Japanese Red Cross Asahikawa Hospital. RESULTS: There were 52 males (85%). Median age was 14 years (range, 5-18 years). There were 9 patients categorized as needing urgent release, 16 as needing repair, and 36 as needing conservative treatment. Mean follow-up ocular movement was 98.0 (95% Confidence Interval [95% CI], 96.8-99.2). Postoperative diplopia was not observed in 96% (79.6%-99.9%) of patients, better than in previous studies. A higher proportion of patients aged 0-12 years needed urgent repair than those aged 13-18 years (Odds Ratio [OR] = 14.2; 95% CI 1.6-683.4; p = 0.0046). There were no differences in Hess area ratio by age group. CONCLUSION: Clinical results with the algorithm were satisfactory. The algorithm is suitable for treatment of pediatric orbital blowout fractures.

Assuntos

Fraturas Orbitárias , Masculino , Humanos , Criança , Adolescente , Estudos Retrospectivos , Fraturas Orbitárias/complicações , Fraturas Orbitárias/cirurgia , Diplopia/complicações , Diplopia/cirurgia , Algoritmos , Progressão da Doença

RESUMO

BACKGROUND AND OBJECTIVES: The most common cause of oculocardiac reflex (OCR) is traction of the extraocular muscles. Therefore, strabismus surgery is highly risk for the development of this complication. This study aimed to investigate whether an association exists between the occurrence of OCR and the type of extraocular muscle manipulated during strabismus in a pediatric population. METHODS: A total of 53 pediatric patients who were operated for strabismus under sevoflurane anesthesia were enrolled in this prospective study. The association between surgical techniques and the occurrence of OCR was investigated. RESULTS: This study included 30 (56.6%) males and 23 (43.4%) females, with a mean age of 8.4 years. Overall, 83 eyes with 93 extraocular muscles were operated. Surgery was performed most frequently on the medial (44.6%) and lateral (36.1%) recti. OCR occurred in 33 (62.3%) patients. OCR was found to be significantly higher in the first operated muscle compared with the second muscle, regardless of muscle type, as identified in the statistical analysis based on the sequence of the operated muscles. CONCLUSIONS: The manipulation of the first extraocular muscle has a higher risk of OCR in the pediatric population undergoing two-muscle surgery for strabismus.

Assuntos

Reflexo Oculocardíaco , Estrabismo , Criança , Feminino , Humanos , Masculino , Músculos Oculomotores/cirurgia , Estudos Prospectivos , Sevoflurano , Estrabismo/cirurgia

RESUMO

Oculocardiac reflex (OCR) has been described to occur with mechanical manipulation of the eye, eyelids or orbit. There are no reports in the literature of OCR during intravitreal injection (IVI). This may be due to the fact that heart rate is not monitored during the procedure. We aimed to evaluate OCR during IVI. A total of 532 patients were enrolled in the study at Asociacion para Evitar la Ceguera en Mexico. Mexico City, Mexico. IVI was performed on one eye in every patient with diabetic retinopathy (DR), age related macular degeneration (AMD) or choroidal neovascularization (CNV) secondary to pathological myopia. Heart rate was monitored with a pulse oximeter before, during and after injection. OCR was defined as a 20% decrease or more of basal heart rate. The population enrolled included 270 females and 262 males with mean age of 63.8 years. A decrease in heart rate of 20% or more occurred in 18 patients during IVI (3.3%; 95% confidence interval 1.85% and 4.92%). OCR was asymptomatic in these patients. OCR occurred in 3.3% of our patients during IVI. Hence, OCR must be considered when performing IVI.

RESUMO

OBJECTIVE: This investigation characterizes the occurrence of oculocardiac reflex (OCR) in conscious rabbits and dogs by observing the effect of an ocular compression stimulus on heart rate (HR). ANIMALS STUDIED: Thirty-four clinically healthy adult rabbits and 15 clinically healthy adult Beagle dogs were studied. PROCEDURES: An electrocardiogram was used to record the heart rhythm and HR continuously. Digital pressure was exerted over the eyelid on right eye, left eye and both eyes together for 1 min, with one-minute intervals between each compression. Variations in HR were observed in each minute by counting complexes on the electrocardiographs. RESULTS: There were no differences in HR between stages without ocular compressions both in dogs and in rabbits. HR reduction caused by ocular compression was statistically significant in rabbits only when both eyes were compressed in contrast with all stages without compression. In dogs, a statistically significant reduction in HR was seen during compression of just the right eye or the left eye compared with the baseline HR, and when both the right and left eyes were compressed together compared with baseline or after compression of the right eye. In dogs, compression of individual eyes produced a change similar to that seen during compression of both eyes. CONCLUSIONS: This study shows that OCR can occur during experimental ocular compression in conscious rabbits and Beagle dogs and characterizes the reduction in HR. Knowledge of this physiological response is important for veterinary anesthetists and ophthalmologists during ophthalmic surgery or eye manipulations.

Assuntos

Reflexo Oculocardíaco/fisiologia , Animais , Cães , Feminino , Frequência Cardíaca , Masculino , Coelhos , Estresse Mecânico

RESUMO

Para evaluar los efectos cardiorespiratorios y los requerimientos de isofluorano en conejos sometidos a cirugía oftálmica tratados en diferentes momentos con tramadol, fue realizado un estudio prospectivo experimental de tipo ciego en 24 conejos distribuidos aleatoriamente en tres grupos de ocho individuos cada uno: grupo tramadol preoperatorio (Tpre), grupo tramadol transoperatorio (Ttrans) y grupo tramadol postoperatorio (Tpos). Cada animal recibió tres inyecciones intramusculares de igual volumen en los periodos pre, intra y postoperatorio, conteniendo tramadol (4mg/kg) o NaCl 0,9%, de acuerdo al momento indicado para cada grupo. La inducción y mantenimiento anestésico fueron realizados con isofluorano en FiO2 1,0. Una vez estabilizado el plano anestésico, fue iniciado el procedimiento quirúrgico. Se evaluaron: frecuencia cardíaca (FC), presión arterial media (PAM), frecuencia respiratoria (f), presión de CO2 al final de la expiración (EtCO2), saturación parcial de oxihemoglobina (SpO2) y concentración de isofluorano al final de la expiración (EtISO). Las variables fueron medidas después de la estabilización anestésica (m1) y cada 10 min desde el inicio de la cirugía, hasta el final del experimento (m10 a m40). La FC, SpO2, f , EtCO2 y EtISO fueron similares entre grupos durante todo el tiempo. La PAM fue significativamente mayor (p<0,01) durante m1 comparada con el resto del tiempo y el grupo Tpre mostró valores inferiores (p=0,04) de este parámetro durante m1 con relación a los demás grupos. El clorhidrato de tramadol promueve la reducción transitoria de la presión arterial en conejos anestesiados con isofluorano y sometidos a cirugía oftálmica. La administración preoperatoria del fármaco no disminuye el requerimiento anestésico y resulta en hipotensión más pronunciada. Adicionalmente, la anestesia con isofluorano, asociada al reflejo óculo-cardiaco, generan hipotensión arterial, fenómeno que debe tenerse en cuenta durante cirugías oftalmológicas.

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To evaluate the cardiorespiratory effects and isoflurane requirements of tramadol applied at different times during ophthalmic surgery, a blind prospective study was made in 24 rabbits, randomly divided into three groups of eight subjects each: pre-operatory tramadol group (Tpre), trans-operatory tramadol group (Ttrans) and post-operatory tramadol group (Tpos), which received three intramuscular injections of equal volume, in the pre, intra and post-operative period, containing tramadol hydrochloride (4 mg/kg) or NaCl 0,9%, according to each group. Anesthetic induction and maintenance was made with isoflurane diluted FiO2 1.0. Once the anesthetic plane was stabilized, surgical procedure was started. Were evaluated heart rate (HR), medium arterial presseure (MAP), respiratory rate (f), end tidal CO2 (EtCO2), Oxihemoglobin saturation (SpO2) and end tidal isoflurane (EtISO). Variables were measured after anesthesia stabilization (m1) and every 10 min after onset of surgery, until the end of experimental protocol (m10 to m40). HR, SpO2, f, EtCO2 and EtISO were similar among groups at all times. MAP were significantly higher (p<0.01) in m1 than in other moments and Tpre group showed lower (p=0.04) values than the other groups at this moment. Tramadol hydrochloride promotes transient reduction of blood pressure in isoflurane anesthetized rabbits subjected to ophthalmic surgery. The preoperative administration of the drug does not reduce the anesthetic requirement and results in a more pronounced hypotension. Additionally, isoflurane anesthesia, associated to oculocardiac reflex generates a hypotension phenomenon that must be taken in to considertation during ophthalmologic surgeries.