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, Emeritus
- Advisory Dean for Student Affairs, Emeritus College of Medicine, New York Medical College, Valhalla, New York
- Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review (CLER) Department of Institutional Accreditation
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:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- McGoldrick KE, Gayer SI. Anesthesia for Opthalmologic Surgery. In: Clinical Anesthesia, 7th ed, Barash PG (Ed), Lippincott Williams & Wilkins, Philadelphia 2013. p.1373.
- Carter K, Faberowski LK, Sherwood MB, et al. A randomized trial of the effect of midazolam on intraocular pressure. J Glaucoma 1999; 8:204.
- Mowafi HA, Aldossary N, Ismail SA, Alqahtani J. Effect of dexmedetomidine premedication on the intraocular pressure changes after succinylcholine and intubation. Br J Anaesth 2008; 100:485.
- Jaakola ML, Ali-Melkkilä T, Kanto J, et al. Dexmedetomidine reduces intraocular pressure, intubation responses and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth 1992; 68:570.
- Drenger B, Pe'er J, BenEzra D, et al. The effect of intravenous lidocaine on the increase in intraocular pressure induced by tracheal intubation. Anesth Analg 1985; 64:1211.
- Thomson MF, Brock-Utne JG, Bean P, et al. Anaesthesia and intra-ocular pressure: a comparative of total intravenous anaesthesia using etomidate with conventional inhalation anaesthesia. Anaesthesia 1982; 37:758.
- Berry JM, Merin RG. Etomidate myoclonus and the open globe. Anesth Analg 1989; 69:256.
- Sinha A, Baumann BC. Anesthesia for ocular trauma. Current Anaesthesia and Critical Care 2010; 21:184.
- Tran DT, Newton EK, Mount VA, et al. Rocuronium versus succinylcholine for rapid sequence induction intubation. Cochrane Database Syst Rev 2015; :CD002788.
- Libonati MM, Leahy JJ, Ellison N. The use of succinylcholine in open eye surgery. Anesthesiology 1985; 62:637.
- Kudlak T. Open-Eye Injury. In: Anesthesiology Problem-oriented Patient Management, 6th ed, Yao F, Fontes M, Malhotra V (Eds), Lippincott Williams & Wilkins, 2008. p.1007.
- 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.
- Ellis DY, Harris T, Zideman D. Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Ann Emerg Med 2007; 50:653.
- Schäfer R, Klett J, Auffarth G, et al. Intraocular pressure more reduced during anesthesia with propofol than with sevoflurane: both combined with remifentanil. Acta Anaesthesiol Scand 2002; 46:703.
- Mowafi HA, Al-Ghamdi A, Rushood A. Intraocular pressure changes during laparoscopy in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia. Anesth Analg 2003; 97:471.
- Lee EJ. Use of nitrous oxide causing severe visual loss 37 days after retinal surgery. Br J Anaesth 2004; 93:464.
- Fu AD, McDonald HR, Eliott D, et al. Complications of general anesthesia using nitrous oxide in eyes with preexisting gas bubbles. Retina 2002; 22:569.
- 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.
- Gefke K, Andersen LW, Friesel E. Lidocaine given intravenously as a suppressant of cough and laryngospasm in connection with extubation after tonsillectomy. Acta Anaesthesiol Scand 1983; 27:111.
- Koç C, Kocaman F, Aygenç E, et al. The use of preoperative lidocaine to prevent stridor and laryngospasm after tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1998; 118:880.
- Weldon BC, Watcha MF, White PF. Oral midazolam in children: effect of time and adjunctive therapy. Anesth Analg 1992; 75:51.
- Zub D, Berkenbosch JW, Tobias JD. Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication. Paediatr Anaesth 2005; 15:932.
- 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.
- Auffarth GU, Vargas LG, Klett J, Völcker HE. Repair of a ruptured globe using topical anesthesia. J Cataract Refract Surg 2004; 30:726.
- 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