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- W4255965972 abstract "Postoperative nausea and vomiting (PONV) is one of the most common adverse effects of general anesthesia. We describe an ophthalmologic complication of an episode of PONV that occurred in the postanesthesia care unit (PACU). A 43-yr-old woman with a history notable for diabetes mellitus, hypertension, end-stage renal disease with renal transplantation three years previously, and bilateral lower extremity cellulitis presented for irrigation and drainage of an abscess in her right foot. Surgery lasted 30 min, and anesthesia with sevoflurane, fentanyl, and nitrous oxide was uneventful. Emergence was unremarkable, but five min after arrival in the PACU, the patient vomited. Her head was immediately turned, and when her head was turned back to the normal position, it was noted that her right eye had propulsed from the orbit. The patient’s head was immobilized in the midline position and 0.9% normal saline was dripped onto the globe. A few minutes later, the patient’s propulsed eye was reduced with manual traction on the eyelid and gentle manual direction of the globe back into the orbit. She was given one dose of ondansetron 4 mg, and her subsequent course in the PACU was uneventful. On the first postoperative day, the patient had no complications related to her eye, and her vision was unimpaired. More careful history and physical examination revealed bilateral exophthalmos as well as the fact that her right eye had propulsed after an episode of emesis several weeks before and that she had manually reduced the globe herself. Propulsion of the globe associated with the Valsalva maneuver has been reported in the aerospace as well as medical literature (1,2). A previous report described a patient in whom propulsion “usually occurred without conscious effort…particularly when the patient was vomiting violently, coughing or sneezing” (2). This patient’s eyes were described as “prominent but not more so than many patients with exophthalmos who cannot propulse their globes” (2). Exophthalmometry studies on random patients indicate that 9 of 10 are able to increase their readings (voluntary proptosis) while performing the Valsalva maneuver (2). However, it is unlikely that the probability of propulsion occurring after a postoperative episode of emesis can be predicted by the amount of preoperative exophthalmos. Nonetheless, in patients with significant exophthalmos, a careful history regarding eye problems related to Valsalva or episodes of vomiting may yield eye-opening results and increase the level of suspicion for this rare event that can be associated with PONV. Ayman Elfar MD Steve D. Barnes MD" @default.
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- W4255965972 date "2000-04-01" @default.
- W4255965972 modified "2023-09-27" @default.
- W4255965972 title "A Real Eye-Opener!" @default.
- W4255965972 doi "https://doi.org/10.1213/00000539-200004000-00051" @default.
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