Eye surgery provides several unique challenges for the anesthesiologist,
including regulation of intraocular pressure, prevention of the
oculocardiac reflex, management of its consequences, control of
intraocular gas expansion, and the need to deal with the
possible systemic effects of ophthalmic drugs. An understanding of
the mechanisms and management of these potential problems can favorably
influence surgical outcome. This chapter also considers specific
techniques of general and regional anesthesia in ophthalmic
The eye can be considered a hollow sphere with a rigid wall.
If the contents of the sphere increase, the intraocular
pressure (normal: 12–20 mm Hg) must rise. For example,
glaucoma is caused by an obstruction to aqueous humor outflow. Similarly,
intraocular pressure will rise if the volume of
blood within the globe is increased. A rise in venous pressure will
increase intraocular pressure by decreasing aqueous drainage and
increasing choroidal blood volume. Extreme changes in arterial blood
pressure and ventilation can also affect intraocular pressure (Table 38–1). Any anesthetic event
that alters these parameters can affect intraocular pressure (eg,
laryngoscopy, intubation, airway obstruction, coughing, Trendelenburg
the Effect of Cardiac and Respiratory Variables on Intraocular Pressure
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