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PubMed1992

A comparison of the day-long antianginal effectiveness of nitroglycerin patches with that of three-times-daily isosorbide dinitrate: a double-blind study using dose titration.

Eight men with stable angina, a positive treadmill test, and demonstrated responsiveness to chronic oral isosorbide dinitrate (ISDN) were studied after they had been taking effective doses of ISDN t.i.d. for at least 2 weeks. Exercise tests were performed every 1-2 h until 19.00 hours over one day after the 08.00 hours application of nitroglycerin patches in a previously titrated dose; on another day after the administration of ISDN capsules q5h; and on a third day after placebo patches and capsules. The mean necessary effective patch dose was 125 cm2 (60-220 cm2). The mean exercise duration to angina rose from 271 to 480 s 1 h after nitroglycerin patches (P less than 0.001). Nitroglycerin patches were superior to the placebo throughout the day, but in a declining degree--by 94 s at 19.00 hours (P less than 0.05). ISDN q5h provided peaks of increased walking time to angina 1 h after each dose, but after 3 h exercise time was down to placebo levels. Furthermore, the peaks were of diminishing amplitude: 200 s at 09.00 hours, 150 s at 14.00 hours, but only 70 s at 19.00 hours. Thus, neither nitrate regimen provided continuous near-peak benefit throughout the 11 h period, although nitroglycerin patches had a significantly greater (P less than 0.05) overall effect during the day.

Administration, Cutaneous↗
PubMed1995

From basal luteinizing hormone (LH) concentrations to the pre-ovulatory LH surge: titration of the physiological effect of gonadotrophin surge-inhibiting/attenuating factor.

Pulsatile luteinizing hormone (LH) release is thought to be controlled by the functional antagonism between gonadotrophin-releasing hormone (GnRH) and the putative ovarian factor gonadotrophin surge-inhibiting/attenuating factor (GnSIF/AF). Our experiments were designed to titrate the input of endogenous basal and follicle stimulating hormone (FSH)-stimulated GnSIF/AF in this system. The effects were studied of five consecutive pulses of GnRH administration (10-250 pmol/pulse/kg rat), 1 h apart, on the self-priming effect in pro-oestrus phenobarbital-blocked rats injected with FSH or saline. In response to the two high pulses of GnRH, a clear GnRH self-priming was demonstrated. However, pulses of 25 pmol GnRH induced only a minor self-priming effect and the LH blood concentrations were within the physiological range. Pulses of 10 pmol GnRH had no effect. FSH suppressed the unprimed LH response and delayed GnRH self-priming by approximately 1 h. Increasing the GnRH pulse frequency of the 25 pmol GnRH pulses from one to three per hour induced pre-ovulatory-like LH surges. The effect was facilitated by ovariectomy to eliminate GnSIF/AF. Thus, the results are consistent with relative inputs of GnRH and GnSIF/AF being responsible for the changes in LH concentration during the ovarian cycle, including the generation of the mid-cycle LH surge.

Animals↗
PubMed2000

Airway occlusion pressure to titrate positive end-expiratory pressure in patients with dynamic hyperinflation.

BACKGROUND: Although the use of external positive end-expiratory pressure (PEEP) is recommended for patients with intrinsic PEEP, no simple method exists for bedside titration. We hypothesized that the occlusion pressure, measured from airway pressure during the phase of ventilator triggering (P0.1t), could help to indicate the effects of PEEP on the work of breathing (WOB). METHODS: Twenty patients under assisted ventilation with chronic obstructive pulmonary disease were studied with 0, 5, and 10 cm H2O of PEEP while ventilated with a fixed level of pressure support. RESULTS: PEEP 5 significantly reduced intrinsic PEEP (mean +/- SD, 5.2 +/- 2.4 cm H2O at PEEP 0 to 3.6 +/- 1.9 at PEEP 5; P < 0.001), WOB per min (12. 6 +/- 6.7 J/min to 9.1 +/- 5.9 J/min; P = 0.003), WOB per liter (1.2 +/- 0.4 J/l to 0.8 +/- 0.4 J/l; P < 0.001), pressure time product of the diaphragm (216 +/- 86 cm H2O. s-1. min-1 to 155 +/- 179 cm H2O. s-1. min-1; P = 0.001) and P0.1t (3.3 +/- 1.5 cm H2O to 2.3 +/- 1.4 cm H2O; P = 0.002). At PEEP 10, no further significant reduction in muscle effort nor in P0.1t (2.5 +/- 2.1 cm H2O) occurred, and transpulmonary pressure indicated an increase in end-expiratory lung volume. Significant correlations were found between WOB per min and P0.1t at the three levels of PEEP (P < 0.001), and between the changes in P0.1t versus the changes in WOB per min (P < 0.005), indicating that P0.1t and WOB changed in the same direction. A decrease in P0.1 with PEEP indicated a decrease in intrinsic PEEP with a specificity of 71% and a sensitivity of 88% and a decrease in WOB with a specificity of 86% and a sensitivity of 91%. CONCLUSION: These results show that P0.1t may help to assess the effects of PEEP in patients with intrinsic PEEP.

Adult↗
PubMed2002

Patient State Index: titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia.

BACKGROUND: The Patient State Index (PSI) uses derived quantitative electroencephalogram features in a multivariate algorithm that varies as a function of hypnotic state. Data are recorded from two anterior, one midline central, and one midline posterior scalp locations. PSI has been demonstrated to have a significant relation to level of hypnosis during intravenous propofol, inhalation, and nitrous oxide-narcotic anesthesia. This multisite study evaluated the utility of PSI monitoring as an adjunct to standard anesthetic practice for guiding the delivery of propofol and alfentanil to accelerate emergence from anesthesia. METHODS: Three hundred six patients were enrolled in this multicenter prospective randomized clinical study. Using continuous monitoring throughout the period of propofol-alfentanil-nitrous oxide anesthesia delivery, PSI guidance was compared with use of standard practice guidelines (both before [historic controls] and after exposure to the PSA 4000 monitor [Physiometrix, Inc., N. Billerica, MA; standard practice controls]). Anesthesia was always administered with the aim of providing hemodynamic stability, with rapid recovery. RESULTS: No significant differences were found for demographic variables or for site. The PSI group received significantly less propofol than the standard practice control group (11.9 microg x kg(-1) x min(-1); P < 0.01) and historic control group (18.2 microg x kg(-1) x min(-1); P < 0.001). Verbal response time, emergence time, extubation time, and eligibility for operating room discharge time were all significantly shorter for the PSI group compared with the historic control (3.3-3.8 min; P < 0.001) and standard practice control (1.4-1.5 min; P < 0.05 or P < 0.01) groups. No significant differences in the number of unwanted somatic events or hemodynamic instability and no incidences of reported awareness were found. CONCLUSIONS: Patient State Index-directed titration of propofol delivery resulted in faster emergence and recovery from propofol-alfentanil-nitrous oxide anesthesia, with modest decrease in the amount of propofol delivered, without increasing the number of unwanted events.

Adolescent↗
PubMed2006

Titration of propofol for anesthetic induction and maintenance guided by the bispectral index: closed-loop versus manual control: a prospective, randomized, multicenter study.

BACKGROUND: This report describes a closed-loop titration of propofol target control infusion based on a proportional-differential algorithm guided by the Bispectral Index (BIS) allowing induction and maintenance of general anesthesia and compares this to manual propofol target control infusion. METHODS: One hundred sixty-four patients scheduled to undergo elective minor or major surgery were prospectively randomized in a multicenter study into the closed-loop (n = 83) or manual target control infusion group (n = 81). The goal was to reach a BIS target of 50 during induction and to maintain it between 40 and 60 during maintenance. For both groups, remifentanil target control infusion was adjusted manually, and ventilation was without nitrous oxide. RESULTS: Closed-loop control was able to provide anesthesia induction and maintenance for all patients. During induction, propofol consumption was lower in the closed-loop group (1.4 +/- 0.5 vs. 1.8 +/- 0.6 mg/kg; P < 0.0001), but the duration was longer (320 +/- 125 vs. 271 +/- 120 s; P < 0.0002). Adequate anesthesia maintenance, defined as the BIS in the range of 40-60, was significantly higher in the closed-loop group (89 +/- 9 vs. 70 +/- 21%; P < 0.0001), with a decrease of the occurrence of BIS less than 40 (8 +/- 8 vs. 26 +/- 22%; P < 0.0001). Time from discontinuation of propofol infusion to tracheal extubation was shorter in the closed-loop group (7 +/- 4 vs. 10 +/- 7 min; P < 0.017). Unwanted somatic events and hemodynamic instability were similar. CONCLUSION: Automatic control of consciousness using the BIS is clinically feasible and outperforms manual control.

Adult↗
PubMed1981

Use of transcutaneous oxygen sensors to titrate PEEP.

The relationship of transcutaneous oxygen tension (PtcO2) to arterial oxygen tension (PaO2), pulmonary shunt (Qsp/Qt), mixed venous oxygen tension (PVO2), and O2 delivery was determined in patients with respiratory failure in order to explore the possible usefulness of PtcO2 to titrate the level of positive end expiratory pressure (PEEP). Transcutaneous oxygen sensors were applied to the chest of surgical ICU adult patients who were in acute postoperative respiratory failure. The patients had mechanical ventilation with volume ventilators and an intermittent mandatory ventilation (IMV) rate, which allowed normal pH and arterial CO2 tension ventilation (PacO2). Swan-Ganz and arterial catheters were inserted. The blood volume was measured by iodinated I-125-serum albumin and brought into the normal range, before the study began, with appropriate volume therapy. Serial cardiorespiratory data were taken before and after PEEP was increased from zero to 20 cm H2O, in 5 cm increments. PtcO2 correlated well with PaO2 and PV-O2; it was inversely correlated with Qsp/Qt. PtcO2 correlated with O2 delivery in only seven severely ill patients mean alveolar-arterial oxygen tension difference [A-aDO2] was 380 mmHg and the pulmonary shunt was 37%). For the eight other patients, variations in the greatly elevated cardiac output associated with hypoxemia led to poor correlations between PtcO2 and O2 delivery. There was no significant depression of cardiac output in any of the studies. We conclude that the continuous noninvasive nature of PtcO2 monitoring greatly increased the safety and simplicity of PEEP optimization and respiratory management of adult patients with respiratory failure.

Blood Pressure↗
PubMed1995

Transdermal fentanyl in combination with initial intravenous dose titration by patient-controlled analgesia.

Two studies including a total of 70 patients evaluated the efficacy and side effects of a combination of initial patient-controlled analgesia (PCA) for dose finding with transdermal fentanyl administration. Patients, requiring strong opioids for severe cancer pain, received intravenous (i.v.) fentanyl on an on-demand basis over a 24 h period. The amount of fentanyl administered was then used for selecting a suitable transdermal therapeutic system (TTS), which remained in place for 72 h. The size of the second TTS was adjusted according to the amount of supplementary i.v. fentanyl required on day 3. Beginning on day 4, oral or subcutaneous morphine was made available as a rescue medication. The use of TTS fentanyl in combination with initial dose titration using PCA resulted in rapid and statistically significant pain relief in both studies. A respiratory rate below 8 per minute was observed in three patients. Due to adequate symptomatic treatment, other moderate and severe symptoms were relatively rare. TTS fentanyl was shown to be an effective, safe and simple method for long-term pain relief in cancer patients and presents an interesting novel option in the treatment of cancer pain.

Administration, Cutaneous↗
PubMed1999

Intravenous titration with morphine for severe cancer pain: report of 28 cases.

BACKGROUND: In a multicenter study, 28 patients with cancer pain and insufficient pain relief with analgesic treatment according to step II of the guidelines of the World Health Organization (WHO) were switched to oral slow-release morphine. METHODS: Patients received intravenous morphine through a patient-controlled pump (PCA) for the first 24 hours (bolus = 1 mg, lockout interval = 5 minutes, maximum dose = 12 mg/hour). From day 2 patients were treated with oral slow-release morphine. Daily doses were calculated from the requirements of the day before. Breakthrough pain was treated with PCA until stable doses were reached (<2 boluses/day) and then with oral immediate-release morphine solution. Pain intensity was reported in a diary four times a day, in addition to mood, activity, and quality of sleep once daily. RESULTS: Mean duration until adequate pain relief reported (<30 on a 101-step numerical scale; NRS) was 5 hours (range = 80-620 minutes). Mean pain intensity was reduced from 67 NRS to 22 NRS. Mean doses of oral morphine were 133 mg/day initially and then 154 mg/day on day 14. Serious adverse events such as respiratory depression were not observed. Two patients terminated the study due to progressive symptoms of gastrointestinal obstruction. Seventy-five percent of the patients evaluated the effectiveness of the analgesic regime as good. CONCLUSIONS: Dose finding with intravenous PCA may be appropriate for a small minority of patients with severe pain. Higher treatment costs and the risk of complications are drawbacks of this method compared with conventional oral titration.

Administration, Oral↗
PubMed1987

Titrating positive end-expiratory pressure therapy in patients with early, moderate arterial hypoxemia.

A prospective randomized study to compare two physiologic end-points for titrating positive end-expiratory pressure (PEEP) was performed in patients with early, moderate arterial hypoxemia after surgery or trauma. All patients initially received 5 cm H2O of PEEP. In group 1 patients, PEEP was increased only if PaO2 decreased below 65 torr on an inspired oxygen fraction (FIO2) of 0.45. PEEP was then added in 2- to 3-cm H2O increments until PaO2 again was above 65 torr. Group 2 patients were treated with incremental PEEP until the PaO2/FIO2 ratio was greater than 300 or physiologic shunt (Qsp/Qt) was less than 0.20. All therapy other than PEEP was similar in the two groups. There were no statistically significant differences in entry PaO2 (mean 85 +/- 11 [SD] and 87 +/- 11 torr in groups 1 and 2, respectively), and Qsp/Qt was 0.22 in each group. Five (28%) of 18 patients in group 1 and 19 (95%) of 20 patients in group 2 received more than 5 cm H2O of PEEP. Between groups 1 and 2 there were no statistically significant differences in days intubated (3.4 +/- 3 vs. 5.3 +/- 5, respectively), ICU days (5.3 +/- 3 vs. 6.6 +/- 5), hospitalization days (26 +/- 24 vs. 28 +/- 24), incidence of pulmonary barotrauma (0/18 vs. 1/20), ICU mortality (22% vs. 20%), or overall mortality (33% vs. 25%). The number of blood gas analyses and cardiac output measurements, and the total hospital charges were also similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Use of a computerized closed-loop sodium nitroprusside titration system for antihypertensive treatment after open heart surgery.

This study evaluates the clinical applicability of administering sodium nitroprusside by a closed-loop titration system compared with a manually adjusted system. The mean arterial pressure (MAP) was registered every 10 and 30 sec during the first 150 min after open heart surgery in 20 patients (group 1: computer regulation) and in ten patients (group 2: manual regulation). The results (16,343 and 2,912 data points in groups 1 and 2, respectively), were then analyzed in four time frames and five pressure ranges to indicate clinical efficacy. Sixty percent of the measured MAP in both groups was within the desired +/- 10% during the first 10 min. Thereafter until the end of observation, the MAP was maintained within +/- 10% of the desired set-point 90% of the time in group 1 vs. 60% of the time in group 2. One percent and 11% of data points were +/- 20% from the set-point in groups 1 and 2, respectively (p less than .05, chi-square test). The computer-assisted therapy provided better control of MAP, was safe to use, and helped to reduce nursing demands.

Adult↗
PubMed1991

Oxygen transport measurements to evaluate tissue perfusion and titrate therapy: dobutamine and dopamine effects.

BACKGROUND: Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of nonsurvivors who developed an early oxygen debt followed by lethal organ failure. The cardiac index, DO2, and VO2 values empirically determined from survivors' patterns were shown to improve outcome in prospective randomized trials. The present study considers these criteria to evaluate the tissue perfusion status as well as the effects of therapy on tissue perfusion and oxygenation. OBJECTIVE: To summarize new information on the temporal patterns of DO2, VO2, and oxygen debt on outcome and the effects of fluids and inotropes on these patterns in a wide range of clinical, temporal, and physiologic conditions. DESIGN: Descriptive analysis based on data gathered prospectively using a specified protocol. PATIENTS: High-risk patients with accidental or elective surgical trauma, and patients with or without sepsis or septic shock and organ failure. SETTING: University-run county hospital with a large trauma service. INTERVENTIONS: Fluids, dobutamine, and dopamine at various times and at various doses throughout critical illness of postoperative, posttraumatic, septic, and hypovolemic patients with and without lethal and nonlethal organ failure. MEASUREMENTS AND MAIN RESULTS: The pattern of DO2 plotted against the corresponding VO2 values in 437 consecutive critically ill surgical patients showed a wide variability and poor correlation probably because complex clinical conditions may obscure the supply-dependent and supply-independent VO2 relationships observed in normal dogs bled or given bacterial infusions. However, the use of specific therapy by well-defined protocols was shown to provide objective evidence of efficacy. Significant increases in DO2 and VO2 were previously shown after whole blood, packed red cells, and colloid administration, but not after crystalloid administration. Dobutamine administration in 715 circumstances in postoperative, traumatic, septic patients and patients with adult respiratory distress syndrome, renal failure, and multiple organ failure significantly improved DO2 and VO2. Dopamine under comparable conditions produced less improvement in DO2 and VO2 than that of dobutamine; most of the VO2 changes were not significant. CONCLUSIONS: The monitored patterns of cardiac index, DO2, and VO2 may be used to evaluate the adequacy of tissue perfusion as well as the relative effectiveness of alternative therapies. Second, these physiologic criteria may be used to titrate therapy in order to achieve optimal outcome. Third, after colloids optimally expand the plasma volume, dobutamine may be used to enhance flow and the distribution of flow in order to improve tissue oxygenation. Vasodilators may be used when hypertensive episodes occur or there is an inadequate response to inotropic agents. Vasopressors are used as a last resort, usually in the terminal or preterminal state.

Acute Kidney Injury↗
PubMed1997

Titrating methylphenidate in children with attention-deficit/hyperactivity disorder: is body mass predictive of clinical response?

OBJECTIVE: To evaluate the hypothesis that gross body mass is functionally related to methylphenidate (MPH) response in children with attention deficit disorder/hyperactivity disorder (ADDH). METHOD: Seventy-six children with ADDH received each of five counterbalanced doses of MPH (placebo, 5 mg, 10 mg, 15 mg, 20 mg) in the context of a double-blind, placebo-controlled, within-subject (crossover) experimental design. Dependent measures included direct observations of attention, academic efficiency, and teacher ratings of behavior in the classroom. RESULTS: Dose-response profiles did not differ across children varying incrementally in body mass, nor were systematic variations in dose-response curve parameters observed across discrete groups of children differing in mean body mass. Neither did these groups differ with respect to gains from placebo at each dose. Finally, body mass failed to predict optimal dose or gains achieved at optimal dose and did not distinguish between drug responders and nonresponders. CONCLUSIONS: Collectively, the findings fail to support the practice of titrating MPH on the basis of body weight in children with ADDH.

Analysis of Variance↗
PubMed1997

Two rapid-dose titrations of sertindole in patients with schizophrenia.

The novel antipsychotic sertindole has demonstrated efficacy in psychosis with an extrapyramidal syndrome profile indistinguishable from placebo. Prior trials of sertindole have increased the dose by 4 mg every third day, whereas the present study evaluated the safety and tolerability of two, previously untested, more rapid dose escalation regimens. Sixteen schizophrenic inpatients entered a 4-day, single-blind placebo washout period in two consecutive groups. All patients received sertindole in 4-mg dose increments up to a maximum dose of 24 mg, which was maintained for 5 days. Dose increases were every other day for group 1 (N = 8) and daily for group 2 (N = 8). Adverse events, electrocardiograms, routine laboratory tests, and plasma sertindole concentrations were recorded. No patient was discontinued because of adverse events. The most frequent adverse events were tachycardia upon orthostatic challenge, nasal congestion, dry mouth, and headache; except for dry mouth, the incidence of these was greater in group 2. All cases of tachycardia were asymptomatic. No clinically significant laboratory abnormalities were detected in either group. In conclusion, 4-mg increases of sertindole every other day seems to be safe. Daily titration was, in general, not well tolerated.

Adult↗
PubMed1999

Titration of postischemic cerebral hypoperfusion by variation of ischemic severity in a murine model of stroke.

OBJECTIVE: Murine models using intraluminal occluding sutures to establish transient focal cerebral ischemia are becoming increasingly widespread, because of advances in transgenic technology and the advent of cerebroprotective strategies to ameliorate postischemic cerebrovascular no-reflow. We hypothesize that the degree of postischemic hypoperfusion is directly related to the severity of the initial ischemic insult. METHODS: Transient ischemia of 45-minute duration was produced using middle cerebral artery occlusion with 10-0 (n = 5), 9-0 (n = 5), 8-0 (n = 6), 7-0 (n = 8), 6-0 (n = 30), or 5-0 (n = 5) sutures. In separate experiments, transient vessel occlusion with 6-0 sutures was performed for 15 (n = 17), 30 (n = 16), or 45 (n = 30) minutes. Sequential laser Doppler measurements of relative cerebral blood flow were obtained, and stroke severity was assessed using neurological deficit scores and infarction volumes. RESULTS: Although relative cerebral blood flow at the time of occlusion and 24 hours thereafter was diminished in parallel with increasing suture diameters, only the use of larger sutures resulted in postischemic no-reflow. As the suture diameter was increased, the resultant reflow was decreased and the stroke outcome worsened. A more than twofold increase in infarction volume (8.0 +/- 3 versus 19.7 +/- 3%, P < 0.05) resulted when ischemia duration was increased from 30 to 45 minutes. CONCLUSION: Titration of the initial ischemic insult leads to corresponding variations in the magnitude of postischemic no-reflow and tissue damage. Therefore, critical control of the severity of the initial injury in studies using intraluminal suture occlusion is warranted.

Animals↗
PubMed1977

Reversible, titrated deep sedation for major office surgery.

We have operated upon 446 consecutive patients in the office, using the controlled titrated method of sedation which we have described. We believe the results are superior to the methods in more common use. A major factor in choosing a narcotic as our one basic drug was the availability of a safe, swift, and effective antidote to it.

Adolescent↗
PubMed1991

Titrated intravenous barbiturates in the control of symptoms in patients with terminal cancer.

Patients with terminal cancer may have a series of severe and dehumanizing physical and psychologic symptoms. To improve symptom control in the final days and hours of life, we administer intravenous barbiturates continuously to provide heavy sedation or continuous somnolence. Titrated dosage is then reduced to a minimum, after a desired steady-state has been achieved. Improved symptom control is provided, and the patient's dignity is maintained until death.

Aged↗
PubMed2003

Serum concentrations and effects of gabapentin and vigabatrin: observations from a dose titration study.

To explore possible concentration-effect relationships, gabapentin (GBP) and vigabatrin (VGB) serum concentrations were obtained from patients participating in an add-on dose-titration trial comparing GBP and VGB in partial epilepsy. Patients randomized to GBP started on 1800 mg/d and could have their dosage increased stepwise to 2400 and 3600 mg/d if seizures persisted. Those randomised to VGB started on 1000 mg/d, and the dose could be increased to 2000 and 4000 mg/d. Blood samples were obtained at steady state, at a nonstandardized time, from 27 patients randomized to GBP and from 36 randomized to VGB. Serum samples were analyzed using high-performance liquid chromatography. The treatment effect was expressed as percentage reduction in number of seizures from baseline. In addition, patients were classified as responders (>50% reduction in number of seizures from baseline) or nonresponders. There was no significant correlation between serum concentrations of GBP and seizure reduction at the lowest dosage, 1800 mg/d (r = -0.02, P = 0.94, Spearman-rank), nor between VGB serum levels and seizure reduction at 1000 mg/d of VGB (r = -0.14, P = 0.44). The serum GBP concentrations among responders to GBP 1800 mg/d were 26 +/- 12 micro mol/L (mean +/- SD), which was not different from serum concentrations in nonresponders, 28+/-13 micro mol/L. Nor was there a difference between serum concentrations of responders and nonresponders to VGB 1000 mg/d (32 +/- 23 and 44 +/- 36 micro mol/L, respectively). Hence, with the present study design we were unable to identify specific target ranges of GBP and VGB serum concentrations.

Acetates↗
PubMed2002

Retrobulbar catheter technique for postoperative titratable analgesia after glaucoma surgery.

PURPOSE: To assess an indwelling retrobulbar catheter for delivery of intraoperative anesthesia and postoperative analgesia in patients undergoing painful cyclodestructive and retinal destructive procedures as treatment of neovascular glaucoma. PATIENTS AND METHODS: The prospective clinical interventional study included all 11 patients undergoing cyclocryocoagulation and/or retinal exocryocoagulation as treatment of neovascular glaucoma due to proliferate ischemic retinopathies. Using a commercially available retrobulbar needle with a diameter of 0.80 mm and a length of 38 mm, 7 mL of a local anesthetic were injected. Through the same needle, a 28-gauge commercially available flexible catheter was introduced into the retrobulbar space, the needle was withdrawn, and the catheter was fixed in place. When the patients began to feel pain during or after surgery, 2 mL of a local anesthetic were reinjected through the catheter. The catheter was removed 24 hours after surgery. RESULTS: Due to increasing pain in the postoperative period, 8 (72.7%) patients received a reinjection 156.3 +/- 94.6 minutes after the preoperative injection. Seven (63.6%) patients requested a second reinjection 268.6 +/- 45.7 minutes after the preoperative injection, and three (27.3%) patients requested a third postoperative injection 333.3 +/- 79.1 minutes after the preoperative injection. Reinjection of the local anesthetic through the catheter markedly decreased the pain within 5 minutes of injection in all patients. CONCLUSIONS: Avoiding side effects of systemic analgesics and sedatives, an indwelling retrobulbar catheter for repeat postoperative injections of local anesthetics is useful and effective for titratable postoperative analgesia after painful cyclodestructive or retinal destructive surgery as treatment of neovascular glaucoma.

Aged↗