British journal of anaesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Deep topical fornix nerve block versus peribulbar block in one-step adjustable-suture horizontal strabismus surgery.
We compared the efficacy of deep topical fornix nerve block anaesthesia (DTFNBA), which does not paralyse the extraocular muscles, with peribulbar block in patients undergoing one-step adjustable-suture horizontal strabismus surgery. Patients with a vertical, oblique squint were excluded from the study. ⋯ DTFNBA is a useful technique for intraoperative adjustable-suture strabismus surgery. It does not alter muscle tone, thus allowing the surgeon to adjust the muscle sutures intraoperatively, and reducing the incidence of under- or over-correction of the squint in the immediate postoperative period.
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This review focuses on the mechanisms and sites of action underlying beta-adrenergic antagonism in perioperative medicine. A large body of knowledge has recently emerged from basic and clinical research concerning the mechanisms of the life-saving effects of beta-adrenergic antagonists (beta-AAs) in high-risk cardiac patients. This article re-emphasizes the mechanisms underlying beta-adrenergic antagonism and also illuminates novel rationales behind the use of perioperative beta-AAs from a biological point of view. ⋯ Despite overwhelming evidence of benefit, beta-AAs are currently under-utilized in the perioperative period because of concerns of potential adverse effects and toxicity. The effects of acute administration of beta-AAs on cardiac function in the compromised patient and strategies to counteract potential adverse effects will be discussed in detail. This may help to overcome barriers to the initiation of perioperative treatment with beta-AAs in a larger number of high-risk cardiac patients undergoing surgery.