Anesthesia for emergent eye surgery
- Alvaro A Macias, MD
Alvaro A Macias, MD
- Instructor in Anesthesia
- Massachusetts Eye and Ear Infirmary
- Harvard Medical School
- Joseph Bayes, MD
Joseph Bayes, MD
- Massachusetts Eye and Ear (Emeritus)
- Assistant Professor of Anesthesia
- Harvard Medical School
- Kathryn E McGoldrick, MD, FCAI(Hon)
Kathryn E McGoldrick, MD, FCAI(Hon)
- Professor and Chair of Anesthesiology
- Emeritus Residency Program Director, Emeritus Assistant Dean for Student Affairs
- College of Medicine, New York Medical College, Valhalla, New York
Anesthetic management of patients presenting for urgent or emergent surgery after penetrating eye injury is challenging primarily because of the risk of extrusion of ocular contents if intraocular pressure becomes elevated. Additional concerns include risk of pulmonary aspiration in patients with a full stomach, and the possibility of associated traumatic injuries (eg, orbital or cranial trauma).
A foreign body in the eye is the most common type of eye trauma, accounting for 35 percent of all eye injuries. Open wounds and contusions each account for about 25 percent of injuries, and the remainder are burns. Nearly 35 percent of eye injuries occur in patients ≤17 years old. Although eye injury is not a significant cause of total blindness, it is the most common cause of monocular blindness.
The anesthetic management of patients undergoing elective eye surgery is discussed separately. (See "Anesthesia for elective eye surgery".)
Emergency and surgical management of specific eye injuries, including open globe injury, conjunctival injury, traumatic hyphema, and retinal detachment, are discussed in other topics:
- McGoldrick KE, Gayer SI. Anesthesia for Opthalmologic Surgery. In: Clinical Anesthesia, 7th ed, Barash PG (Ed), Lippincott Williams & Wilkins, Philadelphia 2013. p.1373.
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- Chiu CL, Jaais F, Wang CY. Effect of rocuronium compared with succinylcholine on intraocular pressure during rapid sequence induction of anaesthesia. Br J Anaesth 1999; 82:757.
- de Boer HD, Driessen JJ, Marcus MA, et al. Reversal of rocuronium-induced (1.2 mg/kg) profound neuromuscular block by sugammadex: a multicenter, dose-finding and safety study. Anesthesiology 2007; 107:239.
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- Seaberg RR, Freeman WR, Goldbaum MH, Manecke GR Jr. Permanent postoperative vision loss associated with expansion of intraocular gas in the presence of a nitrous oxide-containing anesthetic. Anesthesiology 2002; 97:1309.
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- Scott IU, Mccabe CM, Flynn HW, et al. Local anesthesia with intravenous sedation for surgical repair of selected open globe injuries. Am J Ophthalmol 2002; 134:707.
- Gayer S. Rethinking anesthesia strategies for patients with traumatic eye injuries: Alternatives to general anesthesia. Curr Anesth Crit Care 2006; 7:191.
- Boscia F, La Tegola MG, Columbo G, et al. Combined topical anesthesia and sedation for open-globe injuries in selected patients. Ophthalmology 2003; 110:1555.
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- PREOPERATIVE ASSESSMENT
- GENERAL ANESTHESIA
- Goals of anesthesia
- - Anxiolytic premedication
- Induction of anesthesia
- - Monitoring
- - Choice of induction and adjuvant agents
- - Choice of neuromuscular blocking agent for rapid sequence induction
- - Remifentanil intubation as an alternative technique
- - Other considerations
- Maintenance of anesthesia
- Emergence from anesthesia
- Special populations
- - Patients with a difficult airway
- - Pediatric patients
- REGIONAL ANESTHESIA
- SUMMARY AND RECOMMENDATIONS