Anaesthesia in Ophthalmology: Strabismus Special Problems, General Principles

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ANESTHESIA AND ASSOCIATED DISEASES

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Dr Sunita Goel
Lecturer in Anaesthesiology
BJ Wadia Children's Hospital

Ophthalmology :

General Principles:

Children cannot usually be expected to co-operate during eye surgery. Therefore, general anesthesia is required.
Intraocular surgery and surgery of nasolacrimal duct and eyelids require a bloodless field. Smooth general anesthesia with optimal airway, good positioning of the patient and quiet emergence with out coughing or straining is important
The oculocardiac reflex is powerful in children but can be readily blocked I children by giving atropine intravenous in usual dosage (0.02mg/kg) at the time of induction. Monitor the heart rate.
Some children may be under treatment with long acting plasma cholinesterases inhibitors (e.g. phospholine iodide). Significant systemic absorption occurs and may result in toxic symptoms (nausea, vomiting and abdominal pain) and prolonged apnea following succinylcholine. Timolol maleate topical (a ß blocking agent) is used as an anti glaucoma agent in children. It is absorbed from the conjunctiva and may cause bradycardia refractory to atropine and bronchospasm.
Drugs applied to the conjunctivae during surgery may cause systemic effects. Epinephrine and phenylephrine may cause hypertension and arrhythmias, effects which are potentially dangerous especially during halothane anesthesia. Monitor the heart rate and blood pressure carefully with drug instillation and be prepared to discontinue the halothane.
Anesthesia for ophthal must be deep enough to ensure that eyes are immobile and fixed centrally. Smooth extubation with out coughing can be affected by administration of lidocaine 1-2mg intravenously immediately before removing the tube.
Post-operative pain may be troublesome after eye operations requiring full doses of analgesics.

Strabismus: Commonest eye operation in children

Special problems:

Oculocardiac reflex: Severe bradycardia and even cardiac arrest can occur as a result of traction on the extraocular muscle.
Oculo-gastric reflex: Vomiting after eye muscle surgery is very common.
Post-operative pain may be considerable.

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