Ocriplasmin in the Treatment of Vitreomacular Traction in a Patient with Central Retinal Vein Occlusion: A Case Report

Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA®) in the treatment of vitreomacular traction (VMT). Materials and Methods: An 81-year-old man with VMT associated with central retinal vein occlusion in his left eye, was treated with a single intravitreal injection of ocriplasmin (25 μg). Best corrected visual acuity (BCVA), ocular fundus, and optical coherence tomography were examined before and after treatment. Results: Complete release of VMT produced a reduction of central macular thickness, ranging from 459 to 141 μm. BCVA remained stable. Discussion and Conclusions: The use of ocriplasmin was effective in the treatment of VMT. Ocriplasmin represents a valid alternative to conventional pars plana vitrectomy.
Case Rep Ophthalmol 2018;9:357–364

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Repeated Testing With the Hypertonic Saline Assay in Mice for Screening of Analgesic Activity

BACKGROUND: In vivo animal assays are a cornerstone of preclinical pain research. An optimal stimulus for determining the activity of potential analgesics would produce responses of a consistent magnitude on repeated testing. Intraplantar (i.pl.) injection of hypertonic saline (HS) in mice produces robust nociceptive responses to different analgesics, without evidence of tissue damage. Here, we investigated whether the nociceptive response is changed by repeating the injection at different times and sites in a mouse and whether it is attenuated by morphine. METHODS: We conducted randomized and blinded experiments to assess responses to repeated i.pl. 10% HS in female CD-1 mice. An injection of HS was followed by a second injection into the same hind paw at 4 hours, 24 hours, or 7 days. A separate group of mice each received i.pl. injections at 5, 10, and 15 days. In 2 independent experiments, 30 minutes after initial HS injections in the ipsilateral hind paw, mice received HS injection into the contralateral hind paw or ipsilateral forepaw. The ability of morphine to block the nociceptive responses was examined by injecting morphine at 5-day intervals. RESULTS: Repeated injection of HS did not alter the responses at 4 hours (84 vs 75 seconds; mean difference [95% CI], −9 [−40 to 23]; P = .6), 24 hours (122 vs 113 seconds; −6 [−24 to 12]; P = .5), or 7 days (112 vs 113 seconds; −0.3 [−12 to 11]; P = .95) or at multiple injections (day 0, 122 seconds vs day 5, 121 seconds; −0.3 [−28 to 27], P > .99; day 10, 118 seconds; 2.5 [−36 to 41], P = .99; day 15, 119 seconds; 2 [−36 to 38], P = .99). A previous hind paw injection did not change the responses of the contralateral hind paw (right, 93 seconds versus left, 96 seconds; −3 [−20 to 13], P = .7) or of the ipsilateral forepaw (forepaw after HS, 146 seconds versus forepaw after 0.9% saline, 149 seconds; −3 [−28 to 22], P = .8). Morphine dose-dependently attenuated HS responses (control, 94 seconds versus 4 mg/kg, 66 seconds; 29 [−7 to 64], P = .12; versus 10 mg/kg, 27 seconds; 67 [44–90], P

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Minimum Alveolar Concentration-Awake of Sevoflurane Is Decreased in Patients With End-Stage Renal Disease

BACKGROUND: End-stage renal disease (ESRD) has been shown to be associated with abnormal neural function. Clinically used inhaled anesthetic agents typically exert their effect through multiple target receptors in the central nervous system. Pathological changes in the brain may alter sensitivity to inhaled anesthetic agents. This study aimed to determine the minimum alveolar concentration-awake (MACawake) of sevoflurane in patients with ESRD compared to patients with normal renal function. METHODS: Patients underwent inhalational induction of anesthesia and received sevoflurane at a preselected concentration according to a modified Dixon "up-and-down" method starting at 1.0% with a step size of 0.2%. The concentration of sevoflurane used for each consecutive patient was increased or decreased based on a positive or negative response to verbal command in the previous patient. Serum neuron-specific enolase, a biomarker of impaired neurons, was also measured. RESULTS: Forty-one patients were enrolled: 20 with ESRD and 21 as controls. The MACawake of sevoflurane in patients with ESRD was significantly lower than that observed in the control group (0.56% [standard deviation {SD} = 0.10%] vs 0.67% [SD = 0.08%]; P = .031). Patients with ESRD exhibited higher serum neuron-specific enolase levels compared to the control group (16.4 ng/mL [SD = 5.0] vs 8.7 ng/mL [SD = 2.9]; P

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Perceptions of Perioperative Stroke Among Chinese Anesthesiologists: Starting a Long March to Eliminate This Underappreciated Complication

No abstract available

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Preoperative Continuation Versus Interruption of Oral Hypoglycemics in Type 2 Diabetic Patients Undergoing Ambulatory Surgery: A Randomized Controlled Trial

Patients with type 2 diabetes mellitus receiving oral hypoglycemic drugs (OHDs) are usually instructed to stop them before surgery. We hypothesize that continuing OHD preoperatively should result in lower perioperative blood glucose (BG) levels. Ambulatory surgery patients with type 2 diabetes mellitus on OHDs were randomized to continue (n = 69) or withhold (n = 73) OHDs preoperatively. Log-transformed BG levels at pre-, intra-, and postoperative periods were analyzed. Perioperative BG levels were significantly lower (mean, 138 mg/dL; 95% confidence interval, 130–146 mg/dL) in the group that continued versus the group that discontinued OHDs (mean, 156 mg/dL; 95% confidence interval, 146–167 mg/dL; P

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Capnography, Esophageal Intubation, and Capnomanaging Cardiac Arrests in the Operating Room

No abstract available

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Influence of Nasal Tip Lifting on the Incidence of the Tracheal Tube Pathway Passing Through the Nostril During Nasotracheal Intubation: A Randomized Controlled Trial

BACKGROUND: For safe nasotracheal intubation without middle turbinate injury, the tracheal tube should pass through the lower pathway, which is beneath the inferior turbinate and immediately above the nasal floor of the nostril. The purpose of this study was to assess the influence of nasal tip lifting on the incidence of passing preformed nasal Ring-Adair-Elwyn (RAE) tubes through the lower pathway during nasotracheal intubation. METHODS: Patients were randomly assigned to a "nasal tip lifting group" or a "neutral group." For patients in the nasal tip lifting group, an investigator pulled the nasal tip in a cephalad direction when inserting a preformed nasal RAE tube into the nostril after induction of anesthesia. For patients in the neutral group, a tube was inserted with the nasal tip in a neutral position. The pathway by which the tube passed in each patient was identified using a fiberscope. The incidence of the tube passing through the lower pathway was compared between the 2 groups. The incidence of epistaxis was also evaluated. RESULTS: Eighty-six patients were enrolled and completed the study protocol. The incidence of the tracheal tube passing through the lower pathway was significantly higher in the nasal tip lifting group (79.1%) than in the neutral group (51.2%) (relative risk, 1.55; 95% confidence interval, 1.11–2.15; P = .007). Although the incidence of epistaxis was not different between the groups (18.6% vs 32.6%; P = .138), it was lower when the tracheal tube passed nasal cavity through the lower pathway (14.3%) than the upper pathway (46.7%), regardless of the randomized group with adjustment for potentially confounding variables (odds ratio, 0.19; 95% confidence interval, 0.07–0.54; P = .002). CONCLUSIONS: The nasal tip lifting maneuver helped to guide preformed nasal RAE tubes into the lower pathway during nasotracheal intubation. Accepted for publication June 18, 2018. Funding: None. The authors declare no conflicts of interest. Clinical trial number and registry URL: ClinicalTrials.gov (NCT03102255) (https://ift.tt/2v6X4Ya). Reprints will not be available from the authors. Address correspondence to Jung-Man Lee, MD, PhD, Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Republic of Korea. Address e-mail to jungman007@gmail.com. © 2018 International Anesthesia Research Society

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