Peribulbar versus sub-Tenon block in cardiac patients undergoing cataract surgery during warfarin therapy

ObjectiveTo compare sub-Tenon’s block with peribulbar block in patients on oral warfarin therapy undergoing cataract surgery.Materials and methodsWe studied 100 patients on warfarin undergoing cataract surgery; randomly allocated into one of two groups; sub-Tenon’s group (group S, n = 50), and peribulbar group (group P, n = 50). In group (S), sub-Tenon’s injection of 3–5 ml of anesthetic agent was done using a 25 mm sub-Tenon’s cannula. In group (P), the peribulbar block with 3–4 ml of 2% lidocaine–hyaluronidase (10 IU/ml) and 0.5% bupivacaine was done. Pain and akinesia and postoperative complications were assessed.ResultsSub-Tenon group showed significantly higher frequency of hemorrhage compared to peribulbar group (30% versus 8%, p = 0.041), mainly of grade I. The two groups had comparable frequency of subconjunctival hemorrhage (p = 1.000). No patients experienced sight-threatening hemorrhagic complications. Pain was significantly lower in the sub-Tenon group. Akinesia was significantly better (p = 0.025) 2 min after injection and comparable from 4 to 10 min after injection in the peribulbar group. The majority of patients in the two groups reported satisfaction (p = 0.372). The surgeon expressed higher satisfaction with peribulbar block (94%) compared to sub-Tenon’s block (81%) (p = 0.064).ConclusionPeribulbar and sub-Tenon techniques were relatively safe in patients on anticoagulants during cataract operation. We recommend peribulbar technique owing to significantly less bleeding and more satisfactory akinesia response and hence surgeon comfort.     

Dexamethasone bupivacaine versus bupivacaine for peribulbar block in posterior segment eye surgery

AimThe study conducted aims to assess the efficacy, time to first analgesic request, and postoperative inflammatory response after adding dexamethasone to local anesthetic mixture for a peribulbar block in posterior segment eye surgery.Patients and methodsA double-blind randomized study was carried out on 50 ASA I and II patients scheduled for elective posterior segment surgery (vitreoretinal). Patients were allocated randomly into two groups, 25 patients in each group. Group I received equal volumes of 10 ml of a l:1 mixture of bupivacaine 0.5% and saline, supplemented with 4 mg dexamethasone in 1 ml saline and group II received the same local anesthetic mixture (total volume 10 ml) without adding dexamethasone. The duration and onset of motor block, time to first analgesic request, postoperative inflammatory response, and other side effects such as nausea and vomiting were assessed.ResultsPatients receiving peribulbar block were significantly pain free by end of surgery (0 h) (P < 0.05) and throughout the postoperative period in the dexamethasone group at 2 and 6 h postoperatively. The number of patients requiring rescue analgesics was significantly lower with dexamethasone bupivacaine block (P < 0.05). The incidence of postoperative nausea and vomiting was significantly less in the first group (I) in comparison to the other group (II) (P < 0.05) and lastly the level of C reactive protein postoperatively was found to be significantly less in the dexamethasone group than the other one (P < 0.0001).ConclusionAdding dexamethasone to bupivacaine in peribulbar block appears to be a safe and clinically superior adjuvant with less postoperative pain, inflammatory response in patients undergoing posterior segment eye surgery.     

Comparison of buccal and intramuscular dexmedetomidine premedication for arthroscopic knee surgery

STUDY OBJECTIVE: To compare the sedative, anxiolytic, analgesic, hemodynamic, and respiratory effects of buccal dexmedetomidine with intramuscular (IM) dexmedetomidine for premedication in patients undergoing arthroscopic knee surgery during spinal anesthesia. DESIGN: Randomized, placebo-controlled trial. SETTING: University medical center. PATIENTS: 75 ASA physical status I and II patients undergoing arthroscopic knee surgery with spinal anesthesia. INTERVENTIONS: Patients were randomized to one of three groups for premedication: group B, buccal dexmedetomidine 2.5 microg kg(-1); group IM, IM dexmedetomidine 2.5 microg kg(-1); and group P, buccal 0.9% and NaCl 2 mL. MEASUREMENTS: Noninvasive blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation were recorded. Sedation and anxiety levels were consecutively assessed with Ramsay sedation scores and Visual Analog Scale (VAS) scores of anxiety before premedication, before spinal anesthesia, during surgery, and at the end of surgery. Two, 4, and 8 hours after surgery, sedation levels, postoperative VAS pain scores, and consumption of analgesics (diclofenac sodium) were recorded. MAIN RESULTS: Before spinal anesthesia, during surgery, and at the end of surgery, sedation and anxiety scores of the patients receiving buccal or IM dexmedetomidine were, respectively, higher and lower than in group P. Patients receiving buccal dexmedetomidine (group B) had lower requirement of diclofenac sodium than group P and lower pain scores than groups P and IM. Mild hypotension and bradycardia were observed in the buccal and IM dexmedetomidine patients. CONCLUSIONS: Buccal dexmedetomidine for premedication in arthroscopic knee surgery provided equal levels of sedation and anxiolysis, and more evident analgesia compared with IM dexmedetomidine.     

Effects of a single 1200-mg preoperative dose of gabapentin on anxiety and memory

Background

Gabapentin has antihyperalgesic and potential anxiolytic effects. We therefore evaluated the effects of gabapentin premedication on anxiety, amnesia, and sedation. We tested the primary hypothesis that 1200 mg of oral gabapentin 2 to 3 h before surgery reduces preoperative anxiety. Our secondary hypothesis was that gabapentin administration is sedative without causing preoperative amnesia.

Study design

Prospective, randomized and placebo-controlled study.

Methods

Surgical patients having general anaesthesia were randomly assigned to either 1200 mg oral gabapentin (n = 32) or an identical-looking placebo (n = 32) 2 to 3 h before anaesthesia. Anxiety, sedation, and amnesia were quantified before premedication, 2 h thereafter, and postoperatively. Preoperative anxiety was measured using the Spielberger state trait anxiety inventory (STAI state) and the visual analogue scale anxiety (VAS). Memory was assessed with the picture recall test of Snodgrass and Vanderwart. Results were compared with t, Mann-Whitney U, or Chi² tests as appropriate, P < 0.05 was considered statistically significant.

Results

STAI state, our primary outcome, decreased significantly in the gabapentin group, from 37.2 to 30.8, and remained unchanged in the placebo group, from 39.3 to 37.9 (P = 0.003). The VAS score for anxiety also decreased, but not significantly, from 28.2 to 19.2 in the gabapentin group and from 28.7 to 24.7 in the placebo group (P = 0.065). No difference was observed in the amnesic effect; nor did the groups differ in terms of recovery times or sedation scores.

Conclusion

Gabapentin premedication, 1200 mg, provided preoperative anxiolysis without causing sedation or impairing preoperative memory.     

Comparison of lignocaine 2% with adrenaline, bupivacaine 0.5% with or without hyaluronidase and a mixture of bupivacaine, lignocaine and hyaluronidase for peribulbar block analgesia

PURPOSE: Each of the freely available local analgesic agents may be used, alone or in combination, with or without hyaluronidase, epinephrine and sodium bicarbonate for peribulbar block analgesia (PBA). A prospective audit of four solutions was undertaken to rationalize choice of local analgesic agent for PBA. METHODS: A randomized, prospective study on 200 middle-aged to elderly patients undergoing cataract extraction was undertaken to compare the efficacy of: (1) bupivacaine 0.5% (bup 0.5% plain); (2) bupivacaine 0.5% plus hyaluronidase 100 i.u. ml-1 (bup 0.5% hyalase); (3) lidocaine 2% plus epinephrine 1:200 000 (lido 2% epi); or (4) a mixture of lidocaine 2% and bupivacaine 0.5% (2:3 volume per volume mix) containing hyaluronidase 25 i.u. ml-1 (lido/bup/hyalase). A standardized deep peribulbar block technique, akinesia scoring system (each 5 minx4), and supplemental protocol was followed. Onset of block and supplementation rates to achieve akinesia were recorded by a blinded observer; the requirement for augmentation with topical oxybuprocaine or subconjunctival lidocaine during surgery and the time from first PBA injection to the completion of surgery (the duration of surgical access) were also recorded. RESULTS: Groups (N=50) were comparable. Akinesia scores were similar after each agent at 5 min, better with lido 2% epi compared with bup 0.5% plain at 10 min (P<0.05), and better with bup 0.5% hyalase, lido 2% epi, and lido/bup/hyalase, than with bup 0.5% plain at 15 min (P<0.01, <0.01, <0.05, respectively) and at 20 min (P<0.05, <0.05, <0.025, respectively). The supplementation rate at 5 min was least with lido 2% epi, greater with bup 0.5% plain (P<0.01) and bup 0.5% hyalase (P<0.0005) and greatest with lido/bup/hyalase (P<0.0005), but similar in each group at 10, 15 and 20 min. Overall, those given lido 2% epi required the least number of supplemental injections to achieve globe akinesia. Mean supplemental injectate volumes, augmentation rates during surgery and the durations of surgical access provided by each agent were similar. CONCLUSION: All four agents provided adequate analgesia during cataract extraction lasting approximately 95-100 min after PBA injection. Lido 2% epi demonstrated most rapid onset and required least number of injections to establish block. A hyaluronidase effect was evident only after 15 min in the bup 0.5% hyalase and lido/bup/hyalase groups. Bup 0.5% plain was overall the least satisfactory, and the greatest supplementation rate occurred with lido/bup/hyalase, suggesting that either lido 2% epi or bup 0.5% hyalase are the most suitable of the agents tested for this type of surgery.     

Cardiac dysrhythmias during oral surgery. Comparison of hyoscine and droperidol premedication

The incidence of cardiac dysrhythmias during inpatient dental anaesthesia under halothane was studied following either hyoscine or droperidol as a supplement to papaveretum for premedication. Forty-three percent of patients given hyoscine exhibited cardiac dysrhythmias compared to 23 percent of the group given droperidol (p = 0.03). The incidence of dysrhythmias bore no relationship to the age, sex or weight of the patient, nor to the end tidal carbon dioxide tension.     

加巴喷丁对神经病理性疼痛大鼠焦虑样行为和杏仁体基底外侧核NR2B表达的影响

目的观察加巴喷丁对神经病理性疼痛(neuropathic pain,NP)诱发的大鼠焦虑样行为和杏仁体基底外侧核(basolateral nucleus of the amygdale,BLA)N-甲基-D-天门冬氨酸(N-Methyl-DAspartate,NMDA)受体2B亚基(NR2B)表达的影响。方法选择30只健康的3月龄雄性Wistar大鼠,体重250~280g,随机均分为假手术组(S组)、神经病理性疼痛模型组(NP组)、加巴喷丁组(G组)。神经病理性疼痛模型采用右侧坐骨神经慢性压迫损伤(chronic constriction injury,CCI)的方法制备。G组于CCI后3d开始腹腔注射加巴喷丁100mg/kg,每天一次。分别于术后3、7、10和14d测右侧后爪机械缩足阈值(mechanical withdrawal threshold,MWT)和热缩足潜伏期(thermal withdrawal latency,TWL)。术后第14天,通过高架十字迷宫测试神经病理性疼痛对大鼠情绪的影响,计算开放臂进入次数百分比和开放臂停留时间百分比,然后取大鼠BLA组织用RT-PCR、Western blot和免疫荧光方法检测NR2BmRNA和蛋白表达。结果与术前1d比较,术后各时点NP组MWT明显减少、TWL明显缩短(P0.05),而术后3dG组MWT明显减少、TWL明显缩短(P0.05)。与NP组比较,术后7、10和14dG组MWT明显增加、TWL明显延长(P0.05),术后第14天S组和G组的开放臂进入次数百分比和开放臂停留时间百分比明显升高(P0.05),术后第14天BLA区S组和G组NR2BmRNA相对吸光度明显减少、NR2B蛋白表达明显降低(P0.05),而S组和G组平均相对荧光密度值明显下降(P0.05)。结论加巴喷丁具有治疗神经病理性疼痛作用可反转其导致的焦虑样反应并使杏仁体的NR2B表达下调。     

The effect of premedication on preoperative anxiety

The aim of this study was to evaluate the effect of premedication on anxiety, cortisol, residual gastric volume and gastric pH. Following the approval of the institutional Clinical Research Ethics Committee, 100 patients in ASA I-II scheduled for elective gynecologic surgery, were included into a double blind study. Patients were randomly allocated into two groups; the placebo and the premedicated. Oral 10 mg diazepam in the evening before surgery and 1.5 mg midazolam at least 15 min before surgery. The same anesthetic procedure was applied for both groups. Anxiety levels of patients were assessed by using Spielberger State-Trait Anxiety Inventory Scale (STAIs). Blood samples for cortisol measurements were obtained at the preoperative visits, preanesthesia and intraoperative phases. Gastric contents were collected through an orally inserted gastric tube, acidity was measured by using Merck's pH paper. In placebo group, the preanesthetic STAIs values were increased compared to the values obtained at preoperative visit (p < 0.001). The preanesthetic STAIs values were decreased in premedicated group (p < 0.001). The changes of preanesthetic and preoperative visit values were statistically different (p < 0.001). The preanesthetic and intraoperative cortisol values were increased in both groups compared to values of preoperative visit. The augmentation was significantly higher in the placebo group (p < 0.05). Positive correlation was observed between basal state anxiety and basal cortisol values and preanesthetic STAIs and cortisol values in the placebo group (r = 0.325, p < 0.05). These data support that preoperative sedation suppresses the preoperative anxiety and the cortisol augmentation resulting from surgery and stress.     

术前口服酮洛酸和可乐定对上腹部手术患者细胞因子反应的影响

目的：评价术前止痛对上腹部手术病人围手术期细胞因子反应的影响。方法：选择20例拟于全麻下全胃或胃次全切除的患者,单盲随机分成两组。（1）术前止痛组;术前1h口服桐洛酸10mg和可乐定4μg/kg;（2）对照组：术前1h口服等量安慰剂。分别于术前24h、全麻诱导后20min(术前）、诱导后90min(术中）、术后0、1、2、4、6和24h测定患者血清TNF－α、IL-1β、IL-6和IL－10的水平。结果（1）术前止痛组血清IL－6的水平于术后0h有显著上升,术后4h达高峰,而对照组于诱导后90min（术中）即有显著上升,术后2h达高峰;两用IL－6的水平于术后0、1、2h有显著性差异（P＜0．01）,且术前止痛组的峰值显著低于对照组（P＜0．05）。（2）两组TNF－α及IL－10的水平均于术中即有显著上升,术后2h达高峰,但两组TNF－α和IL－10的水平无显著性差异（P＞0．05）。（3）两组IL－1β的浓度在围手术期处于较低的水平,无统计学意义。结论（1）术前口服桐洛酸和乐定在一定程度上降低了术后患者促炎症因子IL－6的水平,对防止严重并发症的发生,具有潜在的治疗意义;（2）创伤后促炎症因子IL－6、TNF－α升同时机体启动内源性抑炎症机制。     

不同速率输注右美托咪定对老年白内障手术患者的镇静效应

目的 观察不同速率输注右美托咪定对老年白内障手术患者球后神经阻滞麻醉下的镇静效应.方法 选择90例60～80岁白内障手术患者,根据应用右美托咪定维持剂量随机均分为右美托咪定Ⅰ组(0.2μg·kg-1·h-1)、Ⅱ组(0.4μg·kg-1·h-1)、Ⅲ组(0.6 μg·kg-1 ·h-1).观察并记录三组患者麻醉前(T0)、神经阻滞完毕即刻(T1)、用药后10 min(T2)、20 min(T3)、30 min(T4)、60 min(T5)的Ramsay评分和MAP、HR、RR、SpO2.结果 T2～T5时各组Ramsay评分高于T0时(P＜0.05),T3～T5时Ⅲ组高于Ⅰ组(P＜0.05).T3～T5时三组HR显著慢于T0时(P＜0.05),以Ⅲ组减慢最明显;T3～T5时三组RR均慢于T0时,但差异无统计学意义;三组间MAP、SpO2差异无统计学意义.结论 静注右美托咪定0.5 μg/kg后以0.2～0.4 μg·kg- 1·h-1维持适合老年白内障手术患者的清醒镇静.     

Propofol and alfentanil for sedation during placement of retrobulbar block for cataract surgery

Study Objective: To determine if the addition of alfentanil to propofol is more effective than propofol alone to provide adequate conditions for placement of a retrobulbar block prior to cataract surgery.Design: Randomized, double-blinded study.Setting: Outpatients at a university hospital.Patients: 40 adult ASA physical status I, II, and III outpatients scheduled for elective cataract surgery.Interventions: Patients were randomly assigned to receive one of four drug combinations prior to the placement of a retrobulbar block: Group 1, propofol alone; Group 2, alfentanil 5 μg/kg plus propofol; Group 3, alfentanil 10 μg/kg plus propofol; Group 4, alfentanil 15 μg/kg plus propofol. All patients were preoxygenated by face mask for two minutes prior to drug administration. The quality of conditions for block placement were determined by: (1) assessing the amount of movement by the patients while the block needle was in place, (2) cooperativeness of the patients during the operation, (3) hemodynamic side effects, (4) incidence and severity of respiratory depression, (5) incidence of nausea and vomiting, (6) recall of placement of the block, and (7) time to discharge from the hospital.Measurements and Main Results: The addition of alfentanil to propofol for sedation prior to placement of the retrobulbar block resulted in a dose-dependent reduction in movement by the patients. However, the highest dose of alfentanil (15 μg/kg) resulted in the greatest frequency (40% of the patients in this group) of respiratory depression (SpO₂ < 90%). All patients were cooperative during the operation and responsive to verbal command within 5 minutes of placement of the block. In addition, all of the patients denied being nauseated, having vomited, or recalling block placement in the recovery room or the next day.Conclusions: The combination of alfentanil and propofol may be used to sedate patients in order to limit movement and provide a cooperative, alert patient with stable hemodynamics and limited respiratory depression during placement of retrobulbar block prior to ophthalmic surgery. However, excessive dosage of these drugs may result in hazardous respiratory depression in this patient population.     

The effects of relaxation breathing on procedural pain and anxiety during burn care

Introduction

Burn patients experience high levels of pain and anxiety during dressing changes. Relaxation breathing is a simple behavioral intervention to manage pain and anxiety. However, the information about the effects of relaxation breathing on pain and anxiety levels for burn patients during dressing changes is limited.

Methods

This study followed a quasi-experimental, pretest-posttest comparison group design without random assignment to groups. A total of 64 burn patients from Daejeon, South Korea were recruited by a convenience sequential sampling approach. With institutional approval and written consent, the experimental group practiced relaxation breathing during dressing change procedures. Data were collected from June to September 2011 using a VAS for pain and a VAS-A for anxiety.

Results

The homogeneity test was used to detect any significant group differences in the demographic data and pretest measures. The pain scores significantly differed between the 2 groups after intervention (RB group vs. control group, P = .01) and over time (pretest vs. posttest, P = .001). The anxiety scores significantly differed between the 2 groups (P = .01) and over time (P = .02).

Conclusion

Relaxation breathing is a simple and inexpensive technique nurses can use to help burn patients manage pain and anxiety during dressing changes.     

Mirtazapine premedication: Effect on preoperative anxiety and propofol dose requirements at different stages of hypnosis

BackgroundMirtazapine is an antidepressant drug that blocks central 5-HT2 receptors with anxiolytic and sleep-promoting effects and theoretically can be used as a premedication.MethodsSixty ASA I-II patients aged 25–50 yr were randomly allocated according to the premedication received 2 h before induction of anesthesia into two equal groups: group M patients received mirtazapine 30 mg tablet mixed with 20 ml of water and group P patients received 20 ml of plain water. Anxiety level was measured by visual analogue scale (VAS) and bispectral index (BIS) electrodes were connected before induction of anesthesia. Intravenous (i.v) infusion of propofol 1% at a rate of 300 ml h^?1 was started to induce hypnosis till a target BIS value of 45 (BIS45) is reached, and then endotracheal intubation is performed after fentanyl and cis-atracuruim being administered. Propofol dose requirements to achieve loss of response to verbal contact (RVC), loss of eyelash reflex (ELR), and a target BIS45 were recorded. Anesthesia was maintained with sevoflurane titrated to BIS value of 40–50 and oxygen/air mixture. Recovery time was recorded. In postanaesthesia care unit (PACU), VAS for pain and Ramsay sedation score were recorded. Patients were discharged from PACU when two consecutive Aldrete scores of 9 or 10 are obtained, and time of PACU stay was recorded.ResultsPreoperative anxiety by VAS and propofol doses required achieving loss of RVC and ELR, and target BIS45 were significantly lower in mirtazapine group. The two groups were comparable with regard to recovery and PACU stay times as well as postoperative pain and anxiety.ConclusionMirtazapine 30 mg oral tablets can be used as a premedication as it reduces preoperative anxiety and hypnotic dose requirements of propofol, and does not prolong recovery time.     

不同剂量右美托咪定和咪达唑仑用于臂丛神经阻滞的效果比较

目的 将右美托咪定(dexmedetomidine,Dex)和咪达唑仑分别用于臂丛神经阻滞患者,对其效果进行比较,并寻找Dex用于臂丛神经阻滞的合适负荷剂量. 方法 择期行上肢手术患者80例,按随机数字表法分为Dex组(D1组、D2组、D3组)和咪达唑仑组(M组),每组20例.4组分别于超声引导臂丛神经阻滞前10 min静脉输注Dex(0.3、0.5 μg/kg和0.8μg/kg)和咪达唑仑(0.05 mg/kg),输注后Dex组和M组分别给予0.5 μg·kg-l·h-1Dex和0.05 mg·kg-1·h4咪达唑仑维持镇静.记录用药前(To)、用药5 min(T1)、臂丛阻滞前即刻(T2)、臂丛阻滞后即刻(T3)、切皮时(T4)及用药30 min (T5)、40 min(T6)、60 min(T7)时的MAP、HR、Sp02、警觉/镇静(observers assessment of alertness/sedation scale,OAMS)评分,并记录发生的副作用. 结果 各组间MAP、HR差异无统计学意义(P＞0.05),M组在T5时SpOz低于其他3组(P＜0.05);D1组OAA/S评分在TrT7时高于M组(P＜0.05),D2组各时点OAA/S评分与M组比较,差异无统计学意义(P＞0.05),D3组OAA/S评分在T3～T5时明显低于M组P＜0.05).Dex组低血压的发生率与负荷剂量呈正相关. 结论 Dex较咪达唑仑更适用于臂丛神经阻滞,静脉泵注Dex 0.5 μg/kg后以0.5 μg·kg-1·h-1速率维持可产生良好的镇静效果,且血流动力学较稳定、副作用较小.     

Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial

BACKGROUND: Preliminary clinical studies have suggested that gabapentin may produce analgesia and reduce the need for opioids in postoperative patients. The aim of the present study was to investigate the opioid-sparing and analgesic effects of gabapentin administered during the first 24 h after abdominal hysterectomy. METHODS: In a randomized, double-blind study, 80 patients received oral gabapentin 1200 mg or placebo 1 h before surgery, followed by oral gabapentin 600 mg or placebo 8, 16 and 24 h after the initial dose. Patients received patient-controlled analgesia with morphine at doses of 2.5 mg with a lock-out time of 10 min for 24 h postoperatively. Pain was assessed on a visual analogue scale (VAS) at rest and during mobilization, nausea, somnolence and dizziness on a four-point verbal scale, and vomiting as present/not present at 2, 4, 22 and 24 h postoperatively. RESULTS: Thirty-nine patients in the gabapentin group, and 32 patients in the placebo group completed the study. Gabapentin reduced total morphine consumption from median 63 (interquartile range 53-88) mg to 43 (28-60) mg (P < 0.001). We observed a significant inverse association between plasma levels of gabapentin at 2 h postoperatively, and morphine usage from 0 to 2 h, and from 0 to 4 h postoperatively (R2 = 0.30, P = 0.003 and R2 = 0.24 P = 0.008, respectively). No significant differences in pain at rest or during mobilization, or in side-effects, were observed between groups. CONCLUSION: Gabapentin in a total dose of 3000 mg, administered before and during the first 24 h after abdominal hysterectomy, reduced morphine consumption with 32%, without significant effects on pain scores. No significant differences in side-effects were observed between study-groups.     

A comparison of triazolam and diazepam as premedication agents for minor gynaecological surgery

Triazolam 0.25 mg, diazepam 10 mg and placebo were compared in a randomized double-blind trial of oral premedication in 90 patients undergoing minor gynaecological surgery. Both triazolam and diazepam produced a significant sedative effect as measured by patient self assessment linear analogue scales but only diazepam was more anxiolytic than placebo. Psychomotor performance assessed by the letter-search test at 3 and 6 hours after awakening showed a decrement in performance in patients receiving triazolam at 3 hours compared with the two other groups. Triazolam was shown to have a pronounced amnesic effect and whilst it might be used for premedication, its lack of anxiolysis coupled with a significant impairment of psychomotor performance at 3 hours after awakening, render the drug unsuitable for premedication in the short stay patient.     

The effect of hyaluronidase on akinesia during cataract surgery

The ability of hyaluronidase to improve akinesis in retrobulbar anesthesia was evaluated in a double-masked study. Forty consecutive patients undergoing cataract surgery were anesthetized with 3 ml of a 1:1 mixture of 4.0% lidocaine and 0.75% bupivacaine solution. In a predetermined randomized fashion, 2 ml of hyaluronidase (300 USP units) were added to half of the syringes, and 2 ml of saline to the remaining half. The level of akinesia was graded in six different positions of gaze. Seventy percent of the hyaluronidase group exhibited complete akinesis, while only 40% of the control group did. The mean scores for four out of six positions of gaze were significantly higher in the hyaluronidase patients than in the control group. Similarly, the hyaluronidase subjects showed a significantly higher sum score for the six sectors than did the control subjects (p = .0001). These results show that hyaluronidase significantly enhances akinesia. It is therefore recommended that it be included in the anesthetic regimen for such surgeries.