Surgical and anesthetic influences of the oculocardiac reflex in adults and children during strabismus surgery

One of the most common untoward occurrences during strabismus surgery at all ages is the oculocardiac reflex. Although typically easily treated, the sudden bradycardia or cardiac arrest may add a few gray hairs to ophthalmologists and anesthesiologists alike as it can be potentially fatal. This updated review of the literature and novel detailed treatment algorithm may prevent patient morbidity and mortality through proper recognition of at-risk patients and rapid treatment through proper communication between surgical and anesthesia physicians/providers.     

Interventions in the diagnosis and adoption of pacemaker therapy in sinus node dysfunction patients: Results from the IMPROVE Brady study

AimsIMPROVE Brady assessed whether a process improvement intervention could increase adoption of guideline-based therapy in sinus node dysfunction (SND) patients.Methods/Results: IMPROVE Brady was a sequential, prospective, quality improvement initiative conducted in India and Bangladesh. Patients with symptomatic bradycardia were enrolled. In Phase I, physicians assessed and treated patients per standard care. Phase II began after implementing educational materials for physicians and patients. Primary objectives were to evaluate the impact of the intervention on SND diagnosis and pacemaker (PPM) implant. SF-12 quality of life (QoL) and Zarit burden surveys were collected pre- and post-PPM implant.A total of 978 patients were enrolled (57.7 ± 14.8 years, 75% male), 508 in Phase I and 470 in Phase II. The diagnosis of SND and implantation of PPM increased significantly from Phase I to Phase II (72% vs. 87%, P < 0.001 and 17% vs. 32%, P < 0.001, respectively). Pacemaker implantation was not feasible in 41% of patients due to insurance/cost barriers which was unaltered by the intervention. Both patient QoL and caregiver burden improved at 6-months post-PPM implant (P < 0.001).ConclusionsA process improvement initiative conducted at centers across India and Bangladesh significantly increased the diagnosis of SND and subsequent treatment with PPM therapy despite the socio-economic constraints.     

Is sofosbuvir/ledipasvir safe for the hearts of children with hepatitis C virus?

Background

Symptomatic bradycardia has been reported in adults treated for chronic hepatitis C using sofosbuvir based regimens.

心动过缓伴ST段压低在病窦综合征诊断中的价值

目的：对心动过缓伴ST段压低的现象进行讨论，评估其在病窦综合征诊断中的价值。方法：31例患者行窦房结功能评估、踏车试验、冠状动脉造影和药物试验。结果：26例完成全部研究，其中，11例判定为病窦综合征，15例窦房结功能正常。两组踏车试验中均有部分患者出现心率反应不良，其冠状动脉造影特征为病变均涉及右冠和／或回旋支，而心率反应正常者多为单纯前降支病变；后者进入药物试验，均观察到慢频率依赖性sT段压低。结论：心动过缓与ST段压低可互为因果，并对窦房结功能是否可逆、病因是否属缺血性有诊断价值。