Methods: In a randomized, double-blinded, placebo-controlled trial, 144 ASA I-II patients, scheduled for elective surgery under general anesthesia were randomly assigned to 1 of 4 groups. Group I received 2 ml of plain NSS, group II received lidocaine 40 mg, group III received thiopental 0.5mg/kg and group IV received metoclopramide 10 mg. All pretreatment drugs were made into 2 ml solutions and were given IV with manual venous occlusion of 1 minute. Propofol was administered after release of venous occlusion. pain was then assessed using a four-point scale and face pain scale during propofol injection. Results: 36 patients (100%) complained of pain in the control group compared with 20 (56%), 22 (61%) and 23 (64%) in the lidocaine, thiopental and metoclopramide groups, respectively (p<0.05). there was no significant difference among the 3 test solution with regards to severity of pain. Nor were there any noted complications 24 hours postoperatively on the injection site. Conclusion: Thiopental and metoclopramide are equally effective as lidocaine in reducing pain during propofol injection when used with manual venous occlusion.
Human ; LIDOCAINE ; THIOPENTAL ; METOCLOPRAMIDE ; PROPOFOL ; PAIN MANAGEMENT ; ANESTHESIA

OBJECTIVE: To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.
METHODS: This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydria. tic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.
RESULTS: Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% 1110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).
CONCLUSION: In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Macular Edema ; Mydriasis ; Retina ; Retinal Diseases ; Telemedicine ; Primary Health Care