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M. Harissi–Dagher, P. Boulos, I. Hardy, J. Guay; Comparison of Anesthetic and Surgical Outcomes of Dacryocystorhinostomy Using Loco–regional versus General Anesthesia . Invest. Ophthalmol. Vis. Sci. 2005;46(13):4429.
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Purpose: Dacryocystorhinostomy (DCR) is a procedure designed to relieve epiphora. Since it is most frequently performed in elderly patients who suffer from co–morbid conditions, avoidance of GA is desirable. The aim of this study is to compare the anesthetic and surgical outcomes of external DCR under loco–regional anesthesia (LA) versus general anesthesia (GA). Methods: Retrospective chart review of all patients who underwent a DCR by one surgeon (IH) over a ten–year period (April 1994 to March 2003). Information such as age, side and duration of surgery was collected for every patient. For patients who received LA, per–operative comfort level was determined by the opioid analgesic doses used. For both LA and GA groups, post–operative pain was inferred by the use of analgesics during the first four hours, and by the length of time to drug request. Similarly, antiemetic drugs administered during the first four hours were also compared. Finally, rates of complications, unplanned admission, recurrence of symptoms and re–intervention were contrasted between study groups. Results: A total of 221 DCR was performed in 209 patients during the study period: 71 under LA and 150 under GA. Patients operated under GA were younger than those operated under LA (64.2 vs. 72.0 years; P<0.001). LA patients had a shorter length of surgery (56.2 vs. 64.0 minutes; P=0.001). Pain was well controlled per–operatively. The type of anesthesia did not influence the number of patients who needed an analgesic nor the time when it was first required post–operatively. The number of doses of antiemetic drug administered in the first four hours after the surgery was however significantly less when LA was used (P=0.03). Excluding ecchymosis (38.0 LA vs. 21.6% GA; P=0.01), the rate of minor complications did not differ between the two groups: infection, inflammation or edema (14.1 vs. 18.2%; P=0.13), hematoma (1.4 vs. 2.7%; P=0.52) or epistaxis (22.5 vs. 14.2%; P=0.44). Rates of unplanned admission (2.8 vs. 5.4%; P=0.37) recurrent symptoms and re–intervention (11.3 vs. 13.1%; P=0.91) were comparable for LA and GA. Conclusions: This study suggests that external DCR performed under LA may be advantageous. The length of surgery is reduced, post–operative side effects are diminished and excluding ecchymosis, the rate of minor complications is not increased. These benefits are desirable in a predominantly elderly population where avoidance of GA is at times primordial.
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