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Query: UMLS:C0012833 (dizziness)
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Adjustable suture surgery has become a popular method of strabismus correction in those cases in which results are less predictable, such as reoperations, thyroid ophthalmopathy, and blind eyes. Complications related to adjustable strabismus surgery are, in general, no different than those related to standard surgical techniques. We noticed a subgroup of patients who experienced significant vaso-vagal responses (V-VR) during postoperative adjustment and sought to discover a method of identifying these patients prior to adjustment. Sixty patients were studied prospectively from July 1991 to July 1992. All patients had surgery under general anesthesia and were adjusted 24 hours later. A positive oculocardiac reflex (OCR) occurred when a 10% or greater intraoperative change in heart rate was associated with traction on an extraocular muscle. A positive V-VR postoperatively consisted of one or more subjective findings (dizziness, light-headedness, nausea, or body temperature changes), and two or more objective findings (10% or greater change in heart rate, hypotension, pallor, diaphoresis, vomiting, disorientation, or loss of consciousness). Variables studied for predictive value included OCR, age, sex, strabismus type, previous surgery, muscle adjusted, and systemic disease. Twenty-five patients (41.6%) had a positive V-VR during adjustment. Twenty-seven patients (45%) had a positive OCR. Eighty-five percent of patients with a positive OCR and 9% of patients with a negative OCR had a positive V-VR. Younger patients were also more likely to have a positive V-VR. A positive intraoperative OCR under general anesthesia during strabismus surgery is highly predictive of a postoperative V-VR during planned adjustment.
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PMID:The intraoperative oculocardiac reflex as a predictor of postoperative vaso-vagal responses during adjustable suture surgery. 825 46

Occasionally, a dental patient presents his/her dentist with a history of hypersensitivity to local anesthetic agents. The symptoms may include immediate reactions to the injection procedure (dizziness, shortness of breath, tachycardia, etc), or delayed reactions to the anesthetic (swelling, urticaria, etc). Although the true incidence of local anesthetic allergy is low, such a history often involves the patient's anxiety regarding the use of the drug in question, and the dentist's apprehension to treat the "problematic" patient. In such cases, hypnosis can play a major role in controlling pain and the associated distress. In the present article, the method concerning the implementation of hypnosis to induce local anesthesia is described and illustrated through case demonstrations.
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PMID:When pharmacologic anesthesia is precluded: the value of hypnosis as a sole anesthetic agent in dentistry. 836 35

Thirty-one patients scheduled for elective cholecystectomy performed through a mini-laparotomy, were randomized to received either combined thoracic epidural anaesthesia/light general anaesthesia and postoperative balanced analgesia with continuous epidural bupivacaine 10 mg.h-1 and morphine 0.2 mg.h-1 for 38 h after surgery plus systemic ibuprofen 600 mg x 8 h-1 (N = 15) or general anaesthesia and postoperative analgesia with systemic morphine and ibuprofen 600 mg x 8 h-1 (N = 16). During postoperative epidural infusion sensory blockade to pinprick was Th4 to L1, and analgesia at rest and during mobilisation was superior compared to systemic morphine and NSAID. There were no significant differences between groups in haemodynamic responses (BP and heart rate) during rest, orthostatic stress and after walking assessed before, 24 and 48 h after operation except for a clinically unimportant lower heart rate (approximately 10 bpm) 48 h after surgery at rest and during orthostatic stress in the epidural group. There was no significant difference between groups in number of patients with a reduction > 20 mmHg (2.7 kPa) in systolic blood pressure during orthostatic stress (two in each group at 24 h) or in number of episodes of dizziness, nausea or vomiting during rest or mobilisation. These results do not support the common belief that low-dose thoracic epidural bupivacaine/morphine may prevent ambulation due to sympathetic blockade or to impaired cardiovascular adaptation to the upright position.
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PMID:Blood pressure and heart rate during orthostatic stress and walking with continuous postoperative thoracic epidural bupivacaine/morphine. 842 97

One single silastic capsule containing nomegestrol acetate, Uniplant, was inserted subcutaneously in 100 women of reproductive age who desired to avoid conception. Insertions and removals of the capsules were made in the gluteal region following intracutaneous local anesthesia with 2% procaine. Eighty women completed one year of use. Eleven women bore the implant for 6-11 months. A total of 1,085 women-months were recorded. One pregnancy occurred, resulting in a Pearl Index of 1.1. Bleeding episodes similar to menstruation occurred in all women but the degree of regularity varied from subject to subject. Amenorrhea developed in the range of 14-18% during the first six months of use but declined to less than 10% during the last six months. Menorrhagia likewise was higher in the first six months (18% in the first month) but fell to less than 10% during the last six months. Spotting was 5% or less. Of the twenty women who did not complete one year of use, nine discontinued because they found other methods were either more practical or less revealing. Three discontinued because of bleeding irregularities, three desired to become pregnant, one became pregnant. Other complaints included dizziness, headache, increased blood pressure, loss of libido, painful breasts and nausea. Over half of the women indicated their desire to continue using the single implant as a contraceptive.
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PMID:One year contraception with a single subdermal implant containing nomegestrol acetate (Uniplant). 843 5

Post-operative dizziness or imbalance is often regarded as 'trivial' and self-limiting and vaguely ascribed to the drugs used in anaesthesia or to haemodynamic changes. While hearing loss after anaesthesia has been documented in several studies, very little attention has been paid to a possible vestibular cause for post-operative dizziness. Twelve patients with post-operative vestibular disorders, with or without concomitant hearing loss, and one patient with tinnitus are described. As effective management for vestibular dysfunction exists, the importance of identifying this potential cause of dizziness is emphasized.
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PMID:Audiovestibular complications of non-otological surgery. 866 8

Sevoflurane was compared with isoflurane in 246 adult ASA class I-III patients undergoing ambulatory surgery. After administration of midazolam 1-2 mg and fentanyl 1 microgram/kg, anesthesia was induced with propofol 2 mg/kg and maintained with either sevoflurane or isoflurane in 60% nitrous oxide to maintain arterial blood pressure at +/- 20% of baseline. Fresh gas flows were 10 L/min during induction and 5 L/min during maintenance. Times to eye opening, command response, orientation, and ability to sit without nausea and/or dizziness were significantly faster after sevoflurane. Significantly more sevoflurane patients met Phase 1 of postanesthesia care unit (PACU) Aldrete recovery criteria (> or = 8) at arrival, 95% vs 81%. Also, significantly more sevoflurane patients were able to complete psychomotor recovery tests during the first 60 min postanesthesia. Discharge times were not different. Sevoflurane patients had significantly lower incidences of postoperative somnolence (15% vs 26%) and of nausea both in the PACU (36% vs 51%) and in the 24-h postdischarge period (9% vs 24%). Patient satisfaction was high overall (sevoflurane 97%, isoflurane 93%). We conclude that sevoflurane is a useful inhaled anesthetic for maintenance of ambulatory anesthesia.
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PMID:A multicenter comparison of maintenance and recovery with sevoflurane or isoflurane for adult ambulatory anesthesia. The Sevoflurane Multicenter Ambulatory Group. 869 11

This study was designed to assess the efficacy of oral transmucosal fentanyl citrate (OTFC) for premedication in an adult population and to determine its effects on anxiety, sedation, gastric volume, and gastric fluid acidity. The fentanyl citrate is incorporated in a lozenge mounted on a handle (oralet). The effects of OTFC, placebo oralet, and no premedication were compared in a prospective, double-blind study on 90 adult ASA physical status I and II patients undergoing same-day admission surgery. Patients were randomly assigned to one of three groups: OTFC group (n = 30), placebo group (n = 30), and control group (n = 30). Arterial blood pressure, heart rate, respiratory frequency, and oxygen saturation determined by pulse oximetry were recorded before any premedication was given, and then every 10 min until the patient was taken to the operating room. Baseline anxiety and sedation levels were assessed to ensure group similarity immediately before premedication was given and at the more anxiety-provoking phase upon entering the operating room. Anxiety levels were rated using the Spielberger State-Trait Anxiety Inventory short form and sedation levels were assessed with the Ramsay scale. Side effects, as reported by the patients, were also recorded. Gastric contents were aspirated via an orogastric tube after induction of anesthesia and were measured for volume and pH. No significant differences were found among the three groups in mean arterial pressure, heart rate, or respiratory frequency. Initial oxygen saturation levels in all groups decreased after 30 min but not less than 96% except for one patient in the OTFC group, who decreased to 88%. On entering the operating room, the OTFC group demonstrated significantly higher levels of anxiolysis than the control group, but no significant differences were seen between the OTFC and the placebo groups or the placebo and control groups. Mean gastric volumes (OTFC, 29 mL; placebo, 26 mL; control, 24 mL) and pH (OTFC, 2.0; placebo, 1.8; control, 2.1) were similar in all groups. There were no significant differences among the groups in levels of sedation achieved. Mild dizziness or light-headedness was the most commonly reported side effect in 23% of the OTFC group. In the OTFC group, 71.4% like the premedicant effect as compared to 46.4% of the placebo group. Most of the groups found the oralet method of premedicant delivery very acceptable. This study demonstrates that the OTFC oralet is an effective anxiolytic in adults. It has minimal side effects and is prepared in an acceptable format. There was no measurable increase in gastric contents or acidity in the oralet groups, compared to those patients who were given nothing by mouth.
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PMID:Oral transmucosal fentanyl citrate for premedication in adults. 871 94

Seventeen percent of all vertiginous patients have benign paroxysmal positional vertigo. Treatment can include occlusion of the posterior semicircular canal for control of these positional vertigo symptoms. More recently, use of an argon laser technique to occlude the posterior membranous semicircular canal has been proposed. However, this laser technique was not tolerated by a diabetic patient. This report describes a new technique using the argon laser to ablate the utricular macula in the affected ear in patients with benign paroxysmal positional vertigo. This procedure is done as outpatient surgery under local anesthesia. The procedure successfully resolved benign paroxysmal positional vertigo in 14 patients. Symptoms in these patients improved from 20-100% (median 87%; mean 80%) as measured by the Dizziness Handicap Inventory.
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PMID:Utricular macular ablation for benign paroxysmal positional vertigo. 876 2

Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were measured at supine rest, during orthostatic stress, and after walking prior to and 24, 48, and 72 h and 48 h postoperatively compared to preoperatively (P < or = 0.008); 16 vs 6 patients presented resting systolic BP values < 100 mm Hg (lower range, 70 mm Hg) post- versus preoperatively (P = 0.048). During orthostatic stress the decrease in systolic BP and concomitant increase in HR was similar post- versus preoperatively (BP, P > 0.3; HR, P > 0.34) and 12 vs 8 patient; (P = 0.45) experienced a systolic BP decrease > 20 mm Hg post- versus preoperatively. After walking, systolic BP was significantly lower postoperatively compared with preoperatively (P < or = 0.01). Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients.
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PMID:Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery. 889 80

A prospective study of two local anaesthesia regimens for female sterilization is presented. A total of 1077 female clients were sterilized via minilaparotomy under local anaesthesia (ML/LA) as outpatients. The clients underwent preoperative screening and received preoperative and continuing counseling. The first 257 of these clients were sedated with an intramuscular injection of pethidine after atropine premedication (presedated group). The other clients (nonsedated group) were premedicated with atropine alone, without sedation. For the presedated group, the mean volume of 1% lignocaine used was 18.3 (SD, 2.2) ml, the mean length of surgical incision was 2.8 (SD, 0.5) cm, and the mean duration of surgical procedure was 15.8 (SD, 5.3) minutes; 8.2% of these clients reported that they felt much pain. In comparison, 7.7% of the nonsedated group clients reported much pain following a mean of 17.7 ml of 1% lignocaine (SD, 2.7) through an incision of mean length 2.5 (SD, 0.5) cm for surgery lasting a mean of 14.5 (SD, 4.5) minutes. Clients who were premedicated with pethidine were more likely to have multiple postoperative complaints, especially dizziness, faintness, headache, nausea, and vomiting. This study found no significant difference in the clinical performance of female sterilization by minilaparotomy, duration of operation, length of incision, amount of local anaesthesia required, or perception of pain between clients who were premedicated with intramuscular pethidine and those who were not.
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PMID:Value of sedative premedication in female sterilization via minilaparotomy: a prospective study of two local anaesthesia regimen. 890 53


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