Klinische Monatsblätter für Augenheilkunde
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In the past few years, there have been many changes in ophthalmic anaesthesia. Application of drugs in general anaesthesia with excellent controllability enhances patient safety and allows a more efficient OR-management. Regional anaesthesia is gaining widespread use for ophthalmic surgery, especially topical anaesthesia for cataract surgery. ⋯ Postoperative nausea and vomiting (PONV) remains a distressing and common problem after strabismus repair in particular in children. The incidence of PONV depends on the type of ophthalmic surgery and drugs applied. To reduce PONV in ophthalmic surgery, application of long-lasting opiates should be avoided, and non-opiate analgesics and, depending on the kind of operation, antiemetic prophylactics are recommended.
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Klin Monbl Augenheilkd · Sep 2001
Review[Differential diagnosis of visual aura in migraine and epilepsy].
Visual phenomena like lightnings, disturbed contours of objects, or skotoma, can be due to ophthalmological diseases, but can also occur as symptoms generated by the central nervous system ("aura") in migraine or epilepsy. A subsequent hemicrania is considered as a hallmark of migraine, but in many cases does not allow for a certain distinction from postictal headaches in patients with focal epilepsy. A detailed analysis of the aura does, however, provide sufficient information for classifying the disorder as an aura in migraine or as a simple partial epileptic seizure in most cases. ⋯ Secondarily generalized seizures, however, may also occur in patients with migraine. Interictal and ictal EEG recordings can be important to prove an epileptic origin, but their sensitivity is low if ictal discharges remain limited to a small brain area. In rare cases, measurements of ictal cerebral perfusion can contribute to the differential diagnosis.
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Klin Monbl Augenheilkd · Aug 2000
Review Case Reports[Brainstem anesthesia with respiratory arrest after retrobulbar block--a case report with a review of literature].
This case shows the time course and typical clinical features of brain stem anaesthesia. It is presumed that it follows accidental injection of local anaesthetic into the subarachnoidal space via the optic nerve sheaths. ⋯ The quick clinical recovery of the patient without any sequelae and the unremarkable results of internal and neurological examines support the diagnosis of brain stem anaesthesia.
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Klin Monbl Augenheilkd · Feb 1994
Review Comparative Study[Peribulbar anesthesia versus retrobulbar anesthesia with facial nerve block. Techniques, local anesthetics and additives, akinesia and sensory block, complications].
Retrobulbar anesthesia (RETRO), combined with a facial block, is the most frequently employed method of anesthesia in cataract surgery. There is, however, an increasing tendency to use peribulbar anesthesia (PERI), which is claimed to provide the same degree of anesthesia and akinesia as RETRO while reducing many of the complications. ⋯ In randomized order, 160 cataract patients received PERI (technique with 2 injections) with 6, 8 or 10 ml of a bupivacaine-lidocaine-hyaluronidase mixture (without facial block) or RETRO (Unsöld technique) with 5 ml of the above mixture, combined with a Nadbath/Rehman facial nerve block (5 ml etidocaine-lidocaine mixture). Measured 20 min after injection (intervening period of oculopression), the smallest ocular motility (Kestenbaum limbus test) was left after RETRO. After administration of PERI - even with a volume of 10 ml - the range of residual ocular motility was always higher, i.e., there was a less reliable globe akinesia than after RETRO. The lid closure force (Straub technique) averaged zero after all methods of anesthesia; however, the smallest spread (highest reliability) was observed after PERI. Complete corneal anesthesia (Draeger esthesiometer) was found in nearly all cases, i.e., RETRO and PERI are comparably effective concerning sensory blockade...