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Introduction Acute rhinosinusitis accounts for most of the cases of orbital infections and is the most common cause of periorbital oedema in children. Up to 10% of patients with orbital complications of acute rhinosinusitis may experience vision loss and other complications such as meningitis, intracranial abscess or even death. Therefore, these patients require prompt diagnosis and proper treatment. Objectives This study aims to report the clinical presentation and management of post-septal orbital complications of acute rhinosinusitis in the paediatric population. Materials and methods A retrospective medical chart review of all children aged under 18 years old who were diagnosed with post-septal orbital complications of acute rhinosinusitis at a tertiary academic hospital, between 01/2007 and 12/2020. Patients were grouped according to the Chandler Classification (groups 2–5). Results Fifty-five children (mean age of 6.91 ± 4.61 years) fulfilled the entry criteria for post-septal orbital complications of acute rhinosinusitis, based on clinical evaluation by an otorhinolaryngologist and CT-scan findings. Forty (72.72%) patients were also evaluated by an ophthalmologist. Most patients were male (76.36%). Twenty-four patients had post-septal cellulitis (43.63%), 21 patients had a subperiosteal abscess (38.18%) and 10 patients had an orbital abscess (18.18%). Eyelid swelling was the most frequent sign, followed by fever. Microbiology varied considerably and gram-positive agents were clearly predominant. Eighteen (32.73%) patients had been treated with oral antibiotics prior to hospital admission, exhibiting a significantly higher risk of recurrence of orbital infection (p = 0.020). Ethmoid and maxillary sinuses were the most involved paranasal sinuses (90.91%). Thirty-three patients (60%) were successfully treated medically, and 22 patients (40%) required surgical drainage. Seven patients (12.73%) developed further complications and six recovered without sequelae. The mean length of hospital stay was 8.0 ± 5.0 days and recurrence of orbital infection occurred in six patients (10.91%). The absolute neutrophil blood count was significantly different amongst Chandler groups (p = 0.021), with higher counts in patients with subperiosteal abscess. The duration of hospitalization was significantly higher in patients submitted to surgery (p Conclusion Post-septal orbital complications of acute rhinosinusitis are infrequent but dangerous events in the paediatric population. Close collaboration with Ophtalmology is paramount, as the child's vision is at risk. Eyelid swelling and proptosis are early signs. CT-scan imaging plays an invaluable role in the diagnosis and decision-making. Predictive indicators for surgery were not found. However, emergency endoscopic nasal surgery with abscess drainage should be considered whenever vision is at risk, if there is no improvement after aggressive medical treatment, and in cases of intracranial complications.

Introdução: A anestesia opiod-free (OFA) é a prática anestésica sem o uso de opioides intraoperatórios, feita através de uma abordagem multimodal que resulta em anestesia satisfatória e uma melhor recuperação sem os danos amplamente conhecidos relacionados aos opióides. Contudo, essa técnica ainda precisa ser avaliada em diversos contextos cirúrgicos. Objetivo: Esta revisão sistemática teve como objetivo comparar abordagens de anestesia geral livre de opioides e anestesia com opióides e sua eficácia sobre variáveis de recuperação pós-operatória de colecistectomias laparoscópicas eletivas. Método: Utilizando os unitermos “opioid free anesthesia”, “nonopioid” e “laparoscopic cholecystectomy”, com o operador booleano ?AND?, foram encontrados 752 artigos nas bases de dados PubMed, Scielo, Cochrane, NBCI e Google Scholar. Os critérios de inclusão eram ensaios clínicos que avaliaram parâmetros de recuperação no pós-operatório de colecistectomias laparoscópicas eletivas como náuseas e vômitos, dor pós-operatória e necessidade de opioides de resgate, dentro do intervalo de 2015 a 2020. Ao final, 6 estudos atenderam aos critérios de inclusão e exclusão. Revisão de literatura: Bakan (2015), utilizando anestesia venosa total, concluiu que o grupo OFA apresentou menor consumo de fentanil no pós-operatório, e nenhum paciente precisou de ondansetrona para Náusea e Vômito no Pós-operatório (NVPO). Shalaby (2018), Elsayea (2019), Toleska (2019), Abdelmoniem (2020) e Ahmed (2020), utilizando abordagens balanceadas, encontraram resultados concordantes entre si. Quatro estudos mostraram menor necessidade de antieméticos para NVPO e todos concluíram que a anestesia sem opióides fornece melhor controle da dor e menor necessidade de opióides no pós-operatório, sem efeitos adversos significativos em comparação com os grupos baseados em opióides. Conclusão: A anestesia sem opióides foi superior à baseada em opioides em relação aos parâmetros analisados na recuperação de pacientes submetidos a colecistectomias laparoscópicas eletivas, promovendo melhor analgesia, menor necessidade de opioides, menor incidência de NVPO e, de acordo com os autores, sempre com estabilidade hemodinâmica.