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
- Assistant Professor of Anesthesia
- Harvard Medical School
- Kathryn E McGoldrick, MD, FCAI(Hon)
Kathryn E McGoldrick, MD, FCAI(Hon)
- Professor and Chair of Anesthesiology
- New York Medical College
Anesthetic management of patients presenting for urgent or emergent eye 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 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. Emergency and surgical management of specific eye injuries, including open globe injury, conjunctival injury, traumatic hyphema, and retinal detachment, are discussed in other topics. (See "Approach to eye injuries in the emergency department" and "Open globe injuries: Emergent evaluation and initial management" and "Traumatic hyphema: Management" and "Conjunctival injury" and "Anesthesia for elective eye surgery" and "Cataract in adults".)
During the preoperative assessment, the anesthesiologist should determine :
●The mechanism of eye trauma, and the possibility of associated traumatic injuries (eg, orbital and/or skull fractures, subdural hematoma, or intracranial trauma).
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- PREOPERATIVE ASSESSMENT
- GENERAL ANESTHESIA
- Goals of anesthesia
- - Anxiolytic premedication
- Induction of anesthesia
- - Choice of neuromuscular blocking agent for rapid sequence induction
- - Other considerations for rapid sequence induction
- - Choice of anesthetic induction and adjuvant agents
- Maintenance of anesthesia
- Emergence from anesthesia
- Special populations
- - Patients with a difficult airway
- - Pediatric patients
- REGIONAL ANESTHESIA
- SUMMARY AND RECOMMENDATIONS