OPHTHALMIC ANAESTHESIA

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OPHTHALMIC ANAESTHESIA

• Dr. Kirti.N.Saxena
• Professor,
• Department of Anaesthesiology,
• Maulana Azad Medical College

www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
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Special Concerns in Ophthalmic Surgery

• Elderly patients with multiple systemic diseases
• Paediatric patients,often premature with
  congenital syndromes
• Limited access to airway
• OCR
• IOP and and anaesthetic interaction
• Systemic effects of ophthalmic medications

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Case.1

• A 60 years old man is referred for cataract
  surgery under monitored anaesthesia care
• He has undergone coronary angioplasty 2 years ago
  and is on the following drugs Tab.
  Atenolol,Tab.Ecospirin and tab.Atorvastatin
• O/E- Pulse-68/min, B.P.-140/80
• Chest and CVS-NAD

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• What other history would you like to take in this
  patient?
• What investigations would you like in this
  patient?
• What special precautions are indicated in this
  patient?

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Advantages of Regional Anaesthesia

• Decreased IOP
• Decreased incidence of haemodynamic fluctuations-
  OCR obtunded
• Less postoperative nausea and vomiting
• Less postoperative care required- Ideal for day
  care surgery

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Monitored Anaesthesia Care with Regional Block

• Day care surgery
• High levels of stress and anxiety-
  Cardiopulmonary stability desired
• Movement during block is dangerous
• complications.
• Face of patient covered with drapes
• Monitor- SpO2,ECG,BP,Resp.

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Regional Anaesthesia

• Topical anaesthesia
• Retrobulbar block- Intraconal
• Peribulbar block- Extraconal
• Subconjunctival- Perilimbal
• Subtenons block
• Facial Blocks

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Drugs used for Regional Blocks

• Lignocaine
• Bupivacaine
• Adrenaline
• Hyaluronidase
• Proparacaine

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Complications of Occular Blocks

• Subconjunctival edema
• Ecchymosis
• Retrobulbar haemorrhage
• Global penetration
• Amaurosis
• Optic Nerve atrophy
• Penetration of optic nerve sheath
• OCR
• Myotoxicity

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Anaesthetic considerations for perforating eye
injuries

• Other associated injuries- Head injury
• Fasting period of 6 hours does not guarantee an
  empty stomach
• Priming with nondepolarising relaxant before
  administering suxamethonium
• Gentle extubation- IV Lignocaine
• Administration of antiemetic before extubation

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Anaesthetic Considerations for Squint Surgery

• Increased risk of malignant hyperthermia and
  neuromuscular disorders
• Occulocardiac reflex
• Postop nausea and vomiting

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Anaesthetic Considerations for Syringing and
Probing

• Age- Paediatric
• Daycare procedure
• Short duration
• Shared field with surgeon
• Blood may enter airway

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Questions often asked in exams

• Causes management of OCR
• Factors affecting IOP means to decrease it
• Prevention Management of PONV
• Systemic effects of ophthalmic medications
• Description of blocks their complications
• Intravitreal injection of gas

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Thank You!
www.anaesthesia.co.in anaesthesia.co.in_at_gmail.c
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