Efficacy of 2 Drops versus 3 Drops Proparacaine 0.5% Ophthalmic Solution for Phacoemulsification Surgery: A Comparative Study

Background and Aim: Phacoemulsification surgery with intraocular lens implantation is routinely done under topical anaesthesia in many centres. No comparative study on the efficacy of number of drops of topical anaesthetics effective for phacoemulsification surgery has been done. This study was conducted to compare the efficacy of 2 drops versus 3 drops proparacaine 0.5% ophthalmic solution for phacoemulsification surgery. Methods: Patients with uncomplicated cataract undergoing phacoemulsification surgery were randomised into two groups. Group 1 (n = 53) received 3 drops of proparacaine 0.5% whereas group 2 (n = 47) received 2 drops of the same solution before the start of surgery. All the patients underwent phacoemulsification with foldable intraocular lens implantation. Each patient’s subjective experience of pain was measured using a 10 point Visual Analogue Pain Scale (VAS). Patient’s cooperation during the surgery was assessed using a 3 point score. Both the evaluating resident doctor and patients were blinded. Results: In group 1, 73.6% patients scored 0, 20.8% scored 1 and 5.7% scored 2 of VAS respectively and in group 2, 89.4%, 6.4%, 4.3% patients scored 0, 1 and 2 of VAS respectively. In patient cooperation, 90.1% and 9.4% patients in group 1 scored 1 and 2 respectively whereas 87.2% and 12.8% patients scored 1 and 2 respectively in group 2. No statistically significant difference in the mean VAS (P = 0.0.55) and patient cooperation score (P = 0.597) was found between the two groups. The mean VAS score was 1.24 ± 0.534 and the mean patient cooperation score was 1.11 ± 0.314. The mean total surgical time was 25.11 ± 2.68 minutes. No additional drops were required for either group. Conclusions: Topical anaesthesia with both 2 drops and 3 drops proparacaine 0.5% ophthalmic solution is effective for phacoemulsification with intraocular lens implantation. Additional anaesthesia may be unnecessary in these cases.

N-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and hypertonic glucose with 72% chromated glycerin in gastric varices

AIM: To compare n-butyl-2-cyanoacrylate, iso-amyl-2-cyanoacrylate and a mixture of 72% chromated glycerin with hypertonic glucose solution in management of gastric varices. METHODS: Ninety patients with gastric varices presented to Endoscopy Unit of Ain Shams University Hospital were included. They were randomly allocated into three groups; each group included 30 patients treated with intravariceal sclerosant injections in biweekly sessions till complete obturation of gastric varices; Group I(n-butyl-2-cyanoacrylate; Histoacryl), Group II(iso-amyl-2-cyanoacrylate; Amcrylate) and Group III(mixture of 72% chromated glycerin; Scleremo with glucose solution 25%). All the procedures were performed electively without active bleeding. Recruited patients were followed up for 3 mo. RESULTS: 26% of Scleremo group had bleeding during puncture vs 3.3% in each of the other two groups with significant difference,(P < 0.05). None of Scleremo group had needle obstruction vs 13.3% in each of the other two groups with no significant difference,(P > 0.05). Rebleeding occurred in 13.3% of Histoacryl and Amcrylate groups vs 0% in Scleremo group with no significant difference. The in hospital mortality was 6.6% in both Histoacryl and Amcrylate groups, while it was 0% in Scleremo group with no significant difference. In the first and second sessions, the amount of Scleremo needed for obturation was significantly high, while the amount of Histoacryl was significantly low. Scleremo was the less costly of the two treatments. CONCLUSION: All used sclerosant substances showed efficacy and success in management of gastric varices with no significant differences except in total amount, cost and bleeding during puncture.

5%葡萄糖加0.45%盐水溶液联合胃肠道补水抢救糖尿病非酮症性高渗昏迷的研究

目的探讨(5%葡萄糖+0.45%盐水)溶液+胃肠道补水抢救糖尿病非酮症性高渗昏迷的应用及其效果。方法分别采用静脉输注生理盐水+胃肠道补水以及应用(5%葡萄糖+0.45%盐水)溶液+胃肠道补水两种补液方式,观察两组生化改变、病情变化和死亡率。结果静脉输注(5%葡萄糖+0.45%盐水)溶液+胃肠道补水能使治疗24h后血钠及血浆渗透压下降更加明显,循环改善时间缩短,死亡率降低。结论静脉输注(5%葡萄糖+0.45%盐水)溶液+胃肠道补水抢救糖尿病非酮症性高渗昏迷疗效明显优于静脉输注生理盐水+胃肠道补水。

伴有2型糖尿病的前列腺增生患者TURP术中应用5%葡萄糖溶液进行冲洗的安全性评价

目的研究伴有2型糖尿病的良性前列腺增生症(BPH)患者行经尿道前列腺切除术(TURP)时,5%葡萄糖溶液作为TURP冲洗液的安全性。方法收集伴有2型糖尿病行TURP术的BPH患者21例,随机收集同期非糖尿病行TURP术的BPH患者52例作为对照。采集病历资料,统计年龄、国际前列腺症状评分(IPSS)、B超计算前列腺重量。术中采用5%GS作冲洗液行TURP术,统计分析两组患者术前、术中30 min、术后30 min和术后1 d即刻血糖,进一步分析两组在手术时间、冲洗液用量、切除腺体重量方面的差异。结果两组患者组内比较,血糖值均随手术时间延长逐渐升高,与术前相比有显著性差异(P<0.01),但术前、术中及术后血糖比较,组间无显著性差异(P>0.05)。无糖尿病相关的严重并发症发生。结论 TURP术中应用5%葡萄糖溶液作为冲洗液可引起血糖升高,但在充分术前准备和熟练手术操作情况下其作为冲洗液对于糖尿病患者也是相对安全的。

生产工艺对葡萄糖注射液分解产物5－HMF的影响

比较了两种葡萄糖注射液生产工艺对分解产物５－羟甲基糠醛（简称５－ＨＭＦ）含量的影响，用正交法考察了生产工艺中影响葡萄糖分解的主要因素。结果证实：在生产周期中受热时间长短，灭菌温度、时间，样品在消毒锅中放置的位置等均是影响葡萄糖分解产物５－ＨＭＦ多少的主要因素。

PVC输液管吸附硝酸甘油作用的研究

目的考察2种颜色输液管(透明、黑色)对5%葡萄糖溶液中的硝酸甘油的吸着性,进而探讨了光对硝酸甘油被吸附的影响.方法模拟临床静脉注射,采用高效液相色谱法定量分析硝酸甘油在注射过程中的浓度变化.结果8h相对0h的药物含量百分数:①在透明PVC输液管中,被吸附的硝酸甘油的量在65%左右;②在黑色PVC输液管中,被吸附的硝酸甘油的量在58%左右.结论PVC输液管对硝酸甘油吸附受光照的影响,避光的PVC输液管吸附减弱,临床使用硝酸甘油时应尽量选用该材质,若不能避免选用,应考虑适当增加剂量.

葡萄糖溶液对小儿非发绀型先天性心脏病矫治术中血糖的影响

目的:观察术中输注5%葡萄糖溶液和乳酸林格溶液,对小儿非发绀型先天性心脏病(先心病)矫治术中血糖的影响。方法:选择60例行择期非发绀型先天性心脏病心脏畸形矫治手术的患儿,随机分为A组和B组。在常规静脉通路建立后,A组以2.4 mL.kg-1.h-1的速度输注5%葡萄糖溶液,B组以相同速度输注乳酸林格溶液。常规注射鱼精蛋白时停止输注。分析术前(T1)、切皮前1 min(T2)、主动脉阻断后10 min(T3)、主动脉开放后10 min(T4)和注射鱼精蛋白后5 min(T5)的血糖、血乳酸和血钾水平。结果:A组和B组病例一般情况,包括年龄、性别、体质量、诊断、手术时间、体外循环时间及主动脉阻断时间比较差异均无统计学意义(P>0.05),A组的血糖在T2、T3、T4时间点显著高于B组(P<0.01和P<0.05)。B组血糖在T2时间点较T1明显降低,并且有5例发生低血糖。结论:对于行心脏手术的非发绀型先心病小儿术中输注5%葡萄糖溶液,能有效防止术中的血糖降低。