Anesthesia for elective 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
The goals of anesthetic care during elective eye surgery are pain-free surgery, facilitation of the surgical procedure, rapid recovery, and minimization of risks associated with surgery and anesthesia.
This topic reviews the techniques for providing analgesia, sedation, or anesthesia during cataract, glaucoma, and vitreoretinal surgery. Other aspects of surgical management of these conditions are discussed separately. (See "Cataract in adults", section on 'Treatment' and "Open-angle glaucoma: Treatment", section on 'Types of therapy' and "Angle-closure glaucoma", section on 'Treatment' and "Retinal detachment", section on 'Treatment'.)
ANESTHESIA FOR CATARACT SURGERY
Cataract surgery is one of the most common procedures requiring anesthetic care .
Preoperative consultation — The preoperative medical evaluation is reviewed in detail elsewhere, including preoperative testing, evaluation of comorbid conditions, and perioperative decisions regarding chronically administered medications. (See "Cataract in adults", section on 'Preoperative medical evaluation'.)
Consultation for anesthetic management emphasizes the following additional considerations :
- The Anesthesia Quality Institute. Anesthesia in the US 2014. https://ecommerce.asahq.org/p-556-anesthesia-in-the-united-states-2014.aspx? (Accessed on October 22, 2014).
- McGoldrick KE, Gayer SI. Anesthesia for Opthalmologic Surgery. In: Clinical Anesthesia, 7th ed, Barash PG (Ed), Lippincott Williams & Wilkins, Philadelphia 2013. p.1373.
- Fedorowicz Z, Lawrence D, Gutierrez P, van Zuuren EJ. Day care versus in-patient surgery for age-related cataract. Cochrane Database Syst Rev 2011; :CD004242.
- Douketis JD, Berger PB, Dunn AS, et al. The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:299S.
- Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2215.
- Jamula E, Anderson J, Douketis JD. Safety of continuing warfarin therapy during cataract surgery: a systematic review and meta-analysis. Thromb Res 2009; 124:292.
- American Society of Anesthesiologists Committee on Standards and Practice Parameters. Practice alert for the perioperative management of patients with coronary artery stents: a report by the American Society of Anesthesiologists Committee on Standards and Practice Parameters. Anesthesiology 2009; 110:22.
- Ramsay RC, Knobloch WH. Ocular perforation following retrobulbar anesthesia for retinal detachment surgery. Am J Ophthalmol 1978; 86:61.
- Edge R, Navon S. Scleral perforation during retrobulbar and peribulbar anesthesia: risk factors and outcome in 50,000 consecutive injections. J Cataract Refract Surg 1999; 25:1237.
- Vohra SB, Good PA. Altered globe dimensions of axial myopia as risk factors for penetrating ocular injury during peribulbar anaesthesia. Br J Anaesth 2000; 85:242.
- Yang YF, Herbert L, Rüschen H, Cooling RJ. Nitrous oxide anaesthesia in the presence of intraocular gas can cause irreversible blindness. BMJ 2002; 325:532.
- 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.
- Lee EJ. Use of nitrous oxide causing severe visual loss 37 days after retinal surgery. Br J Anaesth 2004; 93:464.
- STANDARDS FOR BASIC ANESTHETIC MONITORING. Committee of Origin:Standards and Practice Parameters (APproved by the ASA House of Delegates on October 21, 1986, and last amended on October 20, 2010 with an effective date of July 1, 2011 https://www.asahq.org/For-Members/Standards-Guidelines-and-Statements.aspx (Accessed on January 05, 2015).
- Continuum of depth of sedation: Definition of general anesthesia and levels of sedation/analgesia. Last updated October 21, 2009. American Society of Anesthesiologists (ASA). Available online at: https://www.asahq.org/~/media/For%20Members/Standards%20and%20Guidelines/2012/CONTINUUM%20OF%20DEPTH%20OF%20SEDATION%20442012.pdf (Accessed on September 09, 2014).
- Apfelbaum JL, Caplan RA, Barker SJ, et al. Practice advisory for the prevention and management of operating room fires: an updated report by the American Society of Anesthesiologists Task Force on Operating Room Fires. Anesthesiology 2013; 118:271.
- Kung TA, Kong SW, Aliu O, et al. Effects of vacuum suctioning and strategic drape tenting on oxygen concentration in a simulated surgical field. J Clin Anesth 2016; 28:56.
- Sukcharanjit S, Tan AS, Loo AV, et al. The effect of a forced-air warming blanket on patients' end-tidal and transcutaneous carbon dioxide partial pressures during eye surgery under local anaesthesia: a single-blind, randomised controlled trial. Anaesthesia 2015; 70:1390.
- Leaming DV. Practice styles and preferences of ASCRS members--2002 survey. J Cataract Refract Surg 2003; 29:1412.
- Guise PA. Sub-Tenon anesthesia: a prospective study of 6,000 blocks. Anesthesiology 2003; 98:964.
- Eke T, Thompson JR. The National Survey of Local Anaesthesia for Ocular Surgery. II. Safety profiles of local anaesthesia techniques. Eye (Lond) 1999; 13 ( Pt 2):196.
- Ianchulev T, Litoff D, Ellinger D, et al. Office-Based Cataract Surgery: Population Health Outcomes Study of More than 21 000 Cases in the United States. Ophthalmology 2016; 123:723.
- Lee RM, Thompson JR, Eke T. Severe adverse events associated with local anaesthesia in cataract surgery: 1 year national survey of practice and complications in the UK. Br J Ophthalmol 2016; 100:772.
- Seidenari P, Santin G, Milani P, David A. Peribulbar and retrobulbar combined anesthesia for vitreoretinal surgery using ropivacaine. Eur J Ophthalmol 2006; 16:295.
- Ozcan AA, Ozdemir N, Günes Y, et al. Intraocular pressure, quality of block, and degree of pain associated with ropivacaine in peribulbar block: a comparative randomized study with bupivacaine-lidocaine mixture. Eur J Ophthalmol 2003; 13:794.
- DeBroff BM, Hamilton RC, Loken RG, et al. Retrobulbar anesthesia with 7.5 vs. 0.75 IU/mL of hyaluronidase. Can J Ophthalmol 1995; 30:262.
- Ripart J, Lefrant JY, Prat-Pradal D, et al. Peribulbar versus retrobulbar anesthesia for ophthalmic surgery: an anatomical comparison of extraconal and intraconal injections. Anesthesiology 2001; 94:56.
- Davis DB 2nd, Mandel MR. Posterior peribulbar anesthesia: an alternative to retrobulbar anesthesia. J Cataract Refract Surg 1986; 12:182.
- Hessemer V. [Peribulbar anesthesia versus retrobulbar anesthesia with facial nerve block. Techniques, local anesthetics and additives, akinesia and sensory block, complications]. Klin Monbl Augenheilkd 1994; 204:75.
- Alhassan MB, Kyari F, Ejere HO. Peribulbar versus retrobulbar anaesthesia for cataract surgery. Cochrane Database Syst Rev 2008; :CD004083.
- Ripart J, Mehrige K, Della Rocca R: Local and regional anesthesia for eye surgery. http://www.nysora.com/regional-anesthesia/sub-specialties/3029-local-regional-anesthesia-for-eye-surgery.html (Accessed on March 11, 2017).
- Demirok A, Simşek S, Cinal A, Yaşar T. Peribulbar anesthesia: one versus two injections. Ophthalmic Surg Lasers 1997; 28:998.
- Agrawal V, Athanikar NS. Single injection, low volume periocular anesthesia in 1,000 cases. J Cataract Refract Surg 1994; 20:61.
- Budd J, Hardwick M, Barber K, Prosser J. A single-centre study of 1000 consecutive peribulbar blocks. Eye (Lond) 2001; 15:464.
- Fanning GL. Orbital regional anesthesia. Ophthalmol Clin North Am 2006; 19:221.
- Martin SR, Baker SS, Muenzler WS. Retrobulbar anesthesia and orbicularis akinesia. Ophthalmic Surg 1986; 17:232.
- Grizzard WS, Kirk NM, Pavan PR, et al. Perforating ocular injuries caused by anesthesia personnel. Ophthalmology 1991; 98:1011.
- Hamilton RC, Gimbel HV, Strunin L. Regional anaesthesia for 12,000 cataract extraction and intraocular lens implantation procedures. Can J Anaesth 1988; 35:615.
- Duker JS, Belmont JB, Benson WE, et al. Inadvertent globe perforation during retrobulbar and peribulbar anesthesia. Patient characteristics, surgical management, and visual outcome. Ophthalmology 1991; 98:519.
- Nicoll JM, Acharya PA, Ahlen K, et al. Central nervous system complications after 6000 retrobulbar blocks. Anesth Analg 1987; 66:1298.
- Sanchez-Capuchino A, Meadows D, Morgan L. Local anaesthesia for eye surgery without a facial nerve block. Anaesthesia 1993; 48:428.
- Hansen EA, Mein CE, Mazzoli R. Ocular anesthesia for cataract surgery: a direct sub-Tenon's approach. Ophthalmic Surg 1990; 21:696.
- Stevens JD. A new local anesthesia technique for cataract extraction by one quadrant sub-Tenon's infiltration. Br J Ophthalmol 1992; 76:670.
- Roman SJ, Chong Sit DA, Boureau CM, et al. Sub-Tenon's anaesthesia: an efficient and safe technique. Br J Ophthalmol 1997; 81:673.
- Kumar CM, Dodds C. Evaluation of the Greenbaum sub-Tenon's block. Br J Anaesth 2001; 87:631.
- Lebuisson DA. Simplified and safer peribulbar anaesthesia. Eur J Implant Ref Surg 1990; 2:123.
- Allman KG, Theron AD, Byles DB. A new technique of incisionless minimally invasive sub-Tenon's anaesthesia. Anaesthesia 2008; 63:782.
- Tsuneoka H, Ohki O, Osamu T, Kenji K. Tenons capsule anaesthesia for cataract surgery with IOL implantation. Eur J Implant Ref Surg 1993; 5:29.
- Frieman BJ, Friedberg MA. Globe perforation associated with subtenon's anesthesia. Am J Ophthalmol 2001; 131:520.
- Rüschen H, Bremner FD, Carr C. Complications after sub-Tenon's eye block. Anesth Analg 2003; 96:273.
- Wainwright AC. Positive pressure ventilation and the laryngeal mask airway in ophthalmic anaesthesia. Br J Anaesth 1995; 75:249.
- Lamb K, James MF, Janicki PK. The laryngeal mask airway for intraocular surgery: effects on intraocular pressure and stress responses. Br J Anaesth 1992; 69:143.
- Thomson KD. The effect of the laryngeal mask airway on coughing after eye surgery under general anesthesia. Ophthalmic Surg 1992; 23:630.
- Pablo LE, Ferreras A, Pérez-Oliván S, et al. Comparison of the efficacy and safety of contact versus peribulbar anaesthesia in combined eye surgery. Ophthalmologica 2009; 223:60.
- Geffen N, Carrillo MM, Jin Y, et al. Effect of local anesthesia on trabeculectomy success. J Glaucoma 2008; 17:658.
- Eke T. Anesthesia for glaucoma surgery. Ophthalmol Clin North Am 2006; 19:245.
- Noureddin BN, Jeffrey M, Franks WA, Hitchings RA. Conjunctival changes after subconjunctival lignocaine. Eye (Lond) 1993; 7 ( Pt 3):457.
- Ghali AM, El Btarny AM. The effect on outcome of peribulbar anaesthesia in conjunction with general anesthesia for vitreoretinal surgery. Anaesthesia 2010; 65:249.
- Sohn HJ, Moon HS, Nam DH, Paik HJ. Effect of volume used in sub-Tenon's anesthesia on efficacy and intraocular pressure in vitreoretinal surgery. Ophthalmologica 2008; 222:414.
- Licina A, Sidhu S, Xie J, Wan C. Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery. Cochrane Database Syst Rev 2016; 9:CD009936.
- Gild WM, Posner KL, Caplan RA, Cheney FW. Eye injuries associated with anesthesia. A closed claims analysis. Anesthesiology 1992; 76:204.
- Hamilton RC. A discourse on the complications of retrobulbar and peribulbar blockade. Can J Ophthalmol 2000; 35:363.
- Katz J, Feldman MA, Bass EB, et al. Risks and benefits of anticoagulant and antiplatelet medication use before cataract surgery. Ophthalmology 2003; 110:1784.
- Morgan CM, Schatz H, Vine AK, et al. Ocular complications associated with retrobulbar injections. Ophthalmology 1988; 95:660.
- Capó H, Roth E, Johnson T, et al. Vertical strabismus after cataract surgery. Ophthalmology 1996; 103:918.
- ANESTHESIA FOR CATARACT SURGERY
- Preoperative consultation
- - Anesthetic considerations
- - Ophthalmic considerations
- Monitoring and sedation
- - Needle insertion for regional anesthesia
- - Surgical procedure
- Anesthetic techniques
- - Topical anesthesia
- - Regional anesthesia
- Commonly used agents
- Peribulbar block (extraconal block)
- Retrobulbar block (intraconal block)
- Sub-Tenon block
- - General anesthesia
- ANESTHESIA FOR INTRAOCULAR GLAUCOMA SURGERY
- ANESTHESIA FOR VITREORETINAL SURGERY
- ANESTHETIC COMPLICATIONS
- Ophthalmologic complications
- - Globe or optic nerve perforation
- - Hemorrhage
- - Intramuscular injection
- Oculocardiac reflex manifestations
- Systemic complications
- SUMMARY AND RECOMMENDATIONS