TY  - CHAP
M1  - Book, Section
TI  - Anesthesia for Ophthalmic Surgery
A1  - Bourdeu, Kathrin
A1  - Bayes, Joseph
A1  - Eappen, Sunil
A2  - Longnecker, David E.
A2  - Mackey, Sean C.
A2  - Newman, Mark F.
A2  - Sandberg, Warren S.
A2  - Zapol, Warren M.
PY  - 2017
T2  - Anesthesiology, 3e
AB  - KEY  POINTSEven  patients  with  serious  medical  problems  can  often  undergo  eye  surgery  under  regional  anesthesia  provided  their  medical  condition(s)  are  well  controlled,  they  can  lie  flat  without  moving  for  the  length  of  the  procedure,  and  they  are  able  to  communicate  with  their  ophthalmologist  and  anesthesia  staff.True  ophthalmic  emergencies  are  rare.  Central  retinal  artery  occlusion  and  chemical  burns  require  immediate  treatment.  Uncontrolled  glaucoma,  ruptured  globe,  and  threatened  macula  detachment  are  urgent  conditions  but  can  usually  be  delayed  long  enough  to  allow  appropriate  management  of  the  patient’s  medical  condition.Cataract  and  other  eye  operations  under  regional  anesthesia  have  a  low  risk  of  serious  perioperative  complications.  Regional  anesthesia  greatly  reduces  the  risk  of  pain,  nausea,  and  vomiting  occurring  in  the  immediate  postoperative  period.General  anesthesia  increases  the  risk  of  minor  complications  (eg,  nausea  and  vomiting)  and  in  some  instances  (eg,  patients  with  valvular  heart  disease  or  pulmonary  hypertension)  major  perioperative  complications.  During  general  anesthesia,  akinesis  and  hemodynamic  stability  must  be  maintained  to  avoid  eye  damage.  A  smooth  emergence  and  control  of  pain  and  postoperative  nausea  and  vomiting  are  important.Safe  performance  of  regional  orbital  blocks  requires  knowledge  of  orbital  anatomy,  instruction  by  a  qualified  practitioner,  knowledge  of  possible  complications,  adequate  patient  monitoring,  and  immediate  availability  of  resuscitation  equipment.  Patients  should  be  mildly  sedated  but  cooperative  during  needle  placement  for  orbital  blocks.  Knowledge  or  estimation  of  the  axial  length  of  the  eye  before  performing  retrobulbar  block  may  reduce  the  risk  of  globe  perforation.  Eyes  ≥26  mm  in  length,  with  previous  scleral  buckles,  and  with  enophthalmos  have  greater  potential  for  injury  from  retrobulbar  blocks.  Needles  longer  than  32  mm  in  the  inferolateral  orbit  and  longer  than  25  mm  in  the  medial  orbit  increase  the  risk  of  serious  complications.  Inserting  a  retrobulbar  or  peribulbar  block  needle  below  the  lateral  canthus  (“modified”  inferolateral  insertion  point)  instead  of  the  junction  of  the  medial  and  lateral  third  of  the  lower  eyelid  may  reduce  extraocular  muscle  (EOM)  injury.The  oculocardiac  reflex  (OCR)  can  occur  when  pressure  is  applied  to  the  globe  or  traction  applied  to  the  EOMs.  It  can  present  as  sinus  bradycardia,  atrioventricular  block,  or  asystole.  OCR  is  more  common  during  general  than  regional  anesthesia  and  more  common  in  children  than  adults.  Prompt  cessation  of  the  inciting  maneuver  sometimes  is  sufficient  therapy.  Although  it  is  often  a  fatigable  reflex,  OCR  may  require  treatment  with  glycopyrrolate  or  atropine  if  severe  or  persistent.  The  reflex  can  often  be  prevented  or  abolished  with  an  orbital  block.Coughing  or  “bucking”  increases  intraocular  pressure  (IOP)  and  the  risk  of  intraoperative  eye  damage.  The  increase  in  IOP  from  laryngoscopy  and  intubation  can  be  blunted  by  sufficient  doses  of  propofol,  a  narcotic,  lidocaine,  and  a  muscle  relaxant.  If  a  rapid-sequence  induction  is  considered  with  globe  injury,  the  risk  of  difficulty  in  securing  the  airway  and  the  viability  of  the  eye  should  first  be  assessed.  Rocuronium  (0.6-1.2  mg/kg)  is  often  a  good  choice  for  muscle  relaxant  if  the  intubation  is  anticipated  to  be  easy.  If  succinylcholine  is  deemed  necessary,  a  dose  of  1.5  mg/kg  preceded  by  a  defasciculating  dose  of  rocuronium  is  indicated.  Both  ...
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1144133135
ER  -