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:
- 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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- 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