The postoperative pain of ophthalmic surgery has been widely concerned in recent years. Some patients show enlarged painful areas and neurophotophobia postoperatively. This abnormal increase in noxious irritant signals after surgery is called hyperalgesia. The development of hyperalgesia can result in delayed postoperative recovery for patients. In addition, hyperalgesia can also cause discomfort for patients, and induce patients to use more analgesics, which can have related side effects. TRPV1/TRPA1 is a nociceptor, which can be specifically activated by nociceptive stimuli to induce hyperalgesia. Nevertheless, the pathogenesis of hyperalgesia after ophthalmology surgery has not been fully elucidated, and the molecular signal pathway of how TRPV1 sensitizes and causes hyperalgesia is not yet clear. 

Objective: To construct an ideal and practical method for managing ophthalmic high-value surgical supplies to strengthen the management of ophthalmic operating room. Methods: A visual management system of ophthalmic high-value surgical supplies was established by using information technology connected with hospital information systems, then the data were integrated to construct a monitoring system for real-time status of ophthalmic high-value surgical supplies, including the whole life cycle management of the surgical supplies. Results: Through the establishment of the system for whole life cycle of high-value ophthalmic surgical supplies, the whole process management realized the supplies for preoperative control, intraoperative monitoring and postoperative trace. Conclusion: Constructing the system solves the daily management problem of ophthalmic high-value surgical supplies, reduces the blind area of management, and strengthens the supervision of surgical supplies in the ophthalmic operating room.

Objective: To evaluate the safety and efficacy of dexmedetomidine combined with sufentanil for postoperative patient-controlled intravenous analgesia (PCIA) after transscleral diode laser cyclophotocoagulation (TDLC) in elderly patients with glaucoma. Methods: Eighty elderly glaucoma patients undergoing TDLC were selected and randomly divided into a SD group (n=40) and a S group (n=40) by random number table method. In SD group (n=40), sufentanil 1.5 μg/kg, dexmedetomidine 1.5 μg/kg and tropisetron 4 mg were used for postoperative PCIA, and sufentanil 2 μg/kg and tropisetron 4 mg were used in S Group (n=40). The corresponding drugs in saline solution was added into 100 mL solution with electronic analgesia pump. PCIA was performed immediately after the operation until 24 h after the operation. The basic condition and operation situation of the two groups were observed and compared, and systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), NRS pain score, Ramsay sedation score and non-operation eye intraocular pressure (IOP) at preoperative (T0), after operation (T1), postoperative 6 h (T2), 12 h after operation (T3) and 24 h after operation (T4) were compared, and postoperative adverse reactions such as nausea and vomiting, respiratory depression, restlessness and use of other auxiliary analgesic drug were also compared. Results: There was no significant difference between two groups of patients’ basic and surgical conditions. There was no significant difference between two groups at each time point DBP, non-operation eye IOP and NRS score. SBP at T3 and T4, HR at T2, T3 and T4, and Ramsay score at T2 and T3 in SD group were lower than the S group, the difference was statistically significant. There was no significant difference in the total number of adverse reactions between two groups, but the incidence of nausea and vomiting and restlessness in group SD were lower than those in group respectively, the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the incidence of respiratory depression, dizziness, lethargy and the use of other auxiliary analgesics. The sufentanil usage in group SD was lower than that in group S (P<0.05). Conclusion: PCIA with dexmedetomidine 1.5 g/kg combined with sufentanil 1.5 g/kg does not affect the non-operation eye IOP. It can be safely and effectively applied to postoperative analgesia for elderly patients with glaucoma after TDLC

Objective: To provide a new management system to increase the quality and safety during the operation through applicating the broken window theory in the operating room nursing quality management. Methods: From February 2019 to June 2020, we organized medical staff in the operating room to study the broken window theory, investigated the nursing quality, nursing satisfaction and safety problems in operating room nursing, and then analyze the application effect of the theory in the nursing safety management. Results: The incidence of unsafe events before implementation of the broken window theory were significantly higher than that after the implementation (16.0% vs 4.0%, P<0.05). After the implementation, the scores of nursing safety management, standardized drug use, infection control and basic nursing quality in the operating room were higher than those before the implementation (P<0.05). The satisfaction of surgeons, medical staff and patients increased significantly after implementation as compared with before implementation (P<0.05). Conclusion: The broken window theory effectively provides a more active intervention model than traditional care, and it deserves further application in nursing safety management.

Objective: To compare the effects of different types of non-depolarizing muscle relaxants including rocuronium,cis-atracurium and mivacurium on intraocular pressure of glaucoma patients with elevated intraocular pressure during induction of general anesthesia. Methods: Glaucoma patients with intraocular pressure >21 mmHg were randomly assigned to rocuronium group, cis-atracurium group and mivacurium group. After target controlled infusion of propofol until the bispectral index (BIS) lower than 55, 0.6 mg/kg rocuronium, 0.1 mg/kg cisatracurium and 0.2 mg/kg mivacurium were injected intravenously according to different groups. The flexible laryngeal mask was placed after the train-of-four stimulation (TOF) ratio decreased to 0 and the mechanical ventilation was implemented immediately. General anesthesia was maintained by 1.5–2.0 μg/kg fentanyl and 2%– 3% sevoflurane. Intraocular pressure and hemodynamic parameters were measured before anesthesia induction (T0), after sedation (T1), after muscle relaxation (T2), and after laryngeal mask insertion (T3). Results: The intraocular pressure of patients in rocuronium group, cis-atracurium group and mivacurium group at T1, T2, T3 were lower than baseline (T0), and the difference was statistically significant (P<0.001); There was no significant difference in intraocular pressure at T2 compared with T1 in rocuronium group, cis-atracurium group and mivacurium group (P=0.337, P=0.520 and P=0.062 respectively); The difference of intraocular pressure between T2 and T1 in rocuronium group, cis-atracurium group and mivacurium group were (0.68±4.39), (0.36±3.72) and (1.27±3.91) mmHg respectively and there was no significant difference among the groups (P=0.353). Conclusion: The non-depolarizing muscle relaxants rocuronium, cis-atracurium and mivacurium have no significant effect on the intraocular pressure of glaucoma patients with elevated intraocular pressure, and there is no significant difference among the three muscle relaxants.

Objective: The aim of this study was to compare the efficacy and safety of dexmedetomidine versus midazolam for the monitored anesthesia care (MAC) management of patients undergoing vitreoretinal surgery. Methods: Forty patients undergoing selective vitreoretinal surgery were double-blind and randomly dividedinto midazolam group (group M) and dexmedetomidine group (group D), each group had 20 patients. Patients in both groups were anesthetized with posterior bulbous nerve block. Bispectral index (BIS) monitor was connected and the BIS value was maintained between 70 and 90. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), Ramsay sedation score, numerical rating scale (NRS), surgeon’s and patient’s anesthesia effect score and adverse reactions were recorded during anesthesia and recovery period. Results: Compared with the data of pre-anesthesia, there were statistical differences of the decrease of HR and MAP in group D within the 10 minutes after medication (P<0.05), and the decrease of HR in group D was greater than that in group M (P<0.05). The NRS pain score in group D was significantly lower than that in group M with statistical significance (P<0.001) during the operation and resuscitation, while there was no significant difference in Ramsay sedation score between the two groups during the operation and resuscitation (P>0.05). In terms of adverse reactions to anesthesia, the incidence of spontaneous movement and oxycodone utilization in group D were significantly lower than those in group M (P<0.05). The anesthesia effect scores of surgeons and patients in group D were significantly higher than those in group M (all P<0.001). Conclusion: Dexmedetomidine has better analgesic effect and less adverse reactions than midazolam in vitreoretinal surgery.

Objective: To observe the effects of different oxygen inhalation methods on the changes of vital signs in adult patients undergoing phacoemulsification under topical anesthesia, and to explore the appropriate oxygen inhalation methods in phacoemulsification. Methods: A total of 291 patients who underwent phacoemulsification for cataract extraction in Zhongshan Ophthalmic Center, Sun Yat-sen University from  April 2020 to September 2020 were randomly divided into 3 groups: the simple mask oxygen inhalation group (n=97), the nasal catheter oxygen inhalation group (n=97), and the oxygen-free group (n=97). The oxygen flow of the mask group and the nasal catheter group was 2–4 L/min. Blood pressure, heart rate, and oxygen saturation (SpO2) were monitored at entry into the operating room (T0), at the beginning of surgery (T1), and at the end of surgery (T2). Results: There was no significant difference in vital signs among the 3 groups when entering the operating room, and no significant change in intraoperative blood pressure among the 3 groups (P>0.05). At T2, the blood oxygen saturation of patients with oxygen inhalation was higher than that of the oxygen-free group (P<0.05), but within the normal range. Conclusion: For cataract phacoemulsification patients under topical anesthesia without serious comorbidities, appropriate oxygen inhalation and monitoring hemodynamics can increase the comfort and safety of patients, and oxygen inhalation should be used without affecting surgery manipulation and comfort of patient. 

Objective: To explore the effect of local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil in adult strabismus surgery. Methods: This study was a prospective cohort study. Twenty-four adult patients who underwent strabismus surgery in Beijing Tongren Hospital from October 1, 2020 to May 31, 2021 were selected and divided into local anesthesia group, and sedation and analgesia group, eachwith 12 patients. All patients received local anesthesia with a mixture of 2% lidocaine 10 mL and 0.1% epinephrine 0.1 mL, and intravenous ondansetron 8 mg. Patients in the sedation and analgesia group received intravenous infusion of midazolam 1mg and sufentanil 5 μg, followed by continuous infusion of propofol 0.6–3 mg/(kg·h) and remifentanil 0.01~0.05 μg/(kg·min) to maintain Ramsay sedation score at grade II. Visual Analogue Scale (VAS), bispectral index (BIS), operator’s satisfaction score, patient’s coordination score, nausea and vomiting, oculocardiac reflex, respiratory depression, blood pressure, heart rate and the infusion rate of propofol and remifentanil during operation were recorded in these two groups. Results: In the sedative and analgesic group, the infusion rates of propofol and remifentanil were 0.6–1.8 mg/(kg·h) and 0.01–0.03 μg/(kg·min), respectively. VAS, BIS and the incidence of increased heart rate in the sedation and analgesia group were lower than those in the local anesthesia group (P<0.05); operator’s satisfaction score and the incidence of decreased blood pressure in the sedation and analgesia group were higher than those in the local anesthesia group (P<0.05); there was no significant difference in the incidence of intraoperative nausea and vomiting, oculocardiac reflex, respiratory depression, elevated blood pressure and patient’s coordination score between the two groups (P>0.05). Conclusion: In adult strabismus surgery, local anesthesia assisted with sedation and analgesia of low-dose propofol combined with remifentanil can effectively relieve intraoperative pain, which is safe and reliable.

Objective: To evaluate the changes in corneal volume (CV) and the correlation of corneal biomechanics in adult myopic patients after small incision corneal lens extraction (SMILE) based on the new generation of Corvis^® ST.This paper further demonstrates the value of CV in evaluating corneal biomechanical properties after SMILE and predicting the outcome of refractive surgery. Methods: A total of 72 cases (72 eyes) of adult myopia who were scheduled for SMILE in The Second People’s Hospital of Foshan from January to August 2021 were included in this prospective observational case study. To avoid binocular correlation, a suitable eye for each person was selected for inclusion. Based on the preoperative central corneal thickness (CCT), the cases were divided into a low corneal thickness group (470–<530 μm), a medium corneal thickness group (530–<560 μm), and a high corneal thickness group (≥560 μm). The biomechanical intraocular pressure (bIOP), DA ratiomax (2 mm) (DA2ratio), integrated inverse concave radius (IR), Ambrósio’s relational thickness (ARTh), stiffness parameter applanation 1 (SP-A1),corvis biomechanical index (CBI) and stress-strain index (SSI) were measured by Corvis^® ST. The Pentacam anterior segment analysis system was used to measure partial CV and total CV with a diameter of 3, 5, and 7 mm from the top of the cornea, with an assumed diameter of 10 mm. The changes in corneal biomechanical parameters and CV before SMILE and 3 months after SMILE were compared. The correlation between corneal biomechanical parameters and CV was studied. Data were analyzed by paired and independent sample t-tests. One-way analysis of variance (ANOVA) was used to assess the differences between the corneal thickness groups. Spearman correlation analysis and partial least squares linear regression (PLSLR) were used for correlation analyses. Results: Three months after SMILE, the CV in different areas (CV_3mm, CV_5mm, CV_7mm, and CV_10mm) were significantly lower than those before SMILE, and the differences were statistically significant (all P<0.001). The corneal biomechanical parameters bIOP, ARTh, SP-A1, and SSI were significantly decreased compared with those before the operation (P<0.05). In contrast, the DA2 ratio, IR, and CBI were significantly higher than those before the operation (P<0.05). A comparison of the corneal biomechanical parameters ARTh, SP-A1, DA2 ratio, IR, and CBI in the different corneal thickness groups before and after SMILE showed overall differences among the groups (P<0.05).However, there was no significant change in the SSI between the low and medium corneal thickness groups. The correlation of the preoperative baseline DA2ratio was negatively correlated with CV_3mm and CV_5mm, and positively correlated with CV_10mm; Conversely, ARTh was positively correlated with CV_3mm and CV_5mm, and negatively correlated with CV_10mm; BIOP was positively correlated with CV_10mm; IR was negatively correlated with CV_3mm and CV_5mm, and positively correlated with CV_10mm; SP-A1 was positively correlated with CV_3mm and CV_5mm, and negatively correlated with CV_10mm; CBI was negatively correlated with CV_3mm, CV_5mm, and CV_10mm, while SSI was positively correlated with CV_3mm and negatively correlated with CV_10mm (all P<0.05). At 3 months after SMILE, ARTh was positively correlated with CV_3mm and CV_5mm, and negatively correlated with CV_10mm; CBI was negatively correlated with CV_3mm, and positively correlated with CV_10mm (all P<0.05). Conclusion: This study demonstrated that at 3 months after SMILE, CV_3mm, CV_5mm, CV_7mm, CV_10mm, intraocular pressure, and CCT in the central and peripheral areas decreased significantly compared with to those before the operation, and the more peripheral the area, the more the CV decreased. Three months after SMILE, the new corneal biomechanical parameters of the new generation Corvis^® ST changed significantly compared to those before the operation, and there was a certain correlation between CV in different regions and corneal biomechanical parameters. It is expected that CV in different regions after SMILE can characterize some changes in corneal biomechanical properties after SMILE, and CV may become a parameter factor for characterizing and predicting the development of corneal dilatation.

Objective: To investigate the anesthetic effect and to evaluate the efficacy and safety of combination application of esketamine and propofol in curettage of eyelid tumors of children. Methods: This study selected 70 children who underwent elective eyelid tumor curettage in Foshan Second People’s Hospital from November 2020 to July 2021. They were randomly divided into group A and group B, with 35 cases in each group. Patients in Group A were anesthetized with sevoflurane combined with propofol. Patients in Group B were anesthetized with esketamine combined with propofol. The anesthetic induction time, operation time, recovery time and total recovery time of the two groups were recorded. The haemodynamics and respiratory frequency changes of patients were being monitored before anesthesia, 5 minutes after anesthesia, before the operation and after the operation. The scores of Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) pain, agitation and nausea and vomiting were recorded immediately after the patients awakened and were sent back to the ward. Results: There was no significant difference in anesthesia induction time between the two groups (P>0.05). There was also no significant difference in the haemodynamics and respiratory frequency changes during the anaesthetic process between the two groups (P>0.05). The recovery time and total recovery time in group B were significantly lower than those in group A (P<0.05). The scores of CHEOPS pain, agitation and nausea and vomiting in group B were significantly lower than those in group A immediately after the patients awakened and were sent back to the ward (P<0.05). Besides, the probability of nausea and vomiting after curettage of eyelid tumors was lower in group B than in group A (P<0.05). Conclusion: Combination application of esketamine and propofol in curettage of eyelid tumors of children can provide good anesthetic and analgesic effect and reduce the occurrence of restlessness, nausea and vomiting.