Abstract
Vitreoretinal surgeries require the administration of general anesthesia (GA) in selected groups of patients. The administration of intraoperative rescue narcotic analgesia (IRNA) during GA poses the risk of postoperative nausea and vomiting (PONV). The surgical pleth index (SPI), a crucial component of the adequacy of anesthesia (AoA) guidance of GA, optimizes the intraoperative titration of IRNA. The current analysis evaluated the risk factors for the occurrence of PONV and the oculo-cardiac reflex (OCR) in patients undergoing pars plana vitrectomy (PPV) under AoA guidance. In total, 175 patients undergoing PPV were randomly allocated to receive either GA with SPI-guided IRNA administration using fentanyl alone or in addition to different preoperative analgesia techniques. Any incidence of PONV or OCR was recorded. Obesity, overweight, smoking status, motion sickness, postoperative intolerable pain perception, female gender, fluid challenge and arterial hypertension did not correlate with an increased incidence of PONV or OCR under AoA guidance. Diabetes mellitus, regardless of insulin dependence, was found to correlate with the increased incidence of PONV. The AoA regimen including SPI guidance of IRNA presumably created similar conditions for individual subjects, so no risk factors of the occurrence of PONV or OCR were found, except for diabetes mellitus. We recommend using AoA guidance for GA administration to reduce OCR and PONV rates.
Highlights
Vitreoretinal surgeries (VRS) are increasingly common operations in ophthalmology due to the expansion of the geriatric and diabetic populations
We investigated the influence of the adequacy of anesthesia (AoA) guidance on general anesthesia (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 oculo-cardiac reflex (OCR) and postoperative nausea and vomiting (PONV) [12]
The patients were divided into five equal groups: patients who received general anesthesia (GA); patients who received preoperative analgesia (PA) using metamizole (M); patients who exhibited preprocedural peribulbar block (PBB group) using a mixture of lignocaine and bupivacaine with Hamilton’s technique 1 min before induction of GA; patients who exhibited preprocedural peribulbar block (PBB group) using paracetamol (P); patients who received preventive topical analgesia by triple instillation of 2%
Summary
Vitreoretinal surgeries (VRS) are increasingly common operations in ophthalmology due to the expansion of the geriatric and diabetic populations. VRS are performed under regional anesthesia (RA) accompanied by monitored anesthesia care (MAC) [1,2], there is a growing number of patients (especially among the elderly) who require immobilization on the operating table under general anesthesia (GA) [3]. GA alone is, very often associated with adverse complications due to the use of intraoperative rescue narcotic analgesia (IRNA), which was identified as a risk factor for postoperative nausea and vomiting (PONV) in the first 24 h after VRS. Comfort and satisfaction, and anesthesia may lead to increases in intraocular pressure and blood pressure, deteriorating the effect of the performed VRS (wound dehiscence, iris prolapse and intraocular bleeding) [4]. Insufficient intraoperative analgesia is supposed to lead to life-threatening hemodynamic disturbances, the occurrence of oculo-cardiac reflex (OCR) and increased postoperative pain perception. In order to minimize this negative impact, different techniques of pre-emptive analgesia (PA)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
