ANESTHESIA FOR OPHTHALMIC SURGERY

Click to edit Master subtitle style Dr. H.J. LALENOH, Sp.An

BAGIAN ANESTESIOLOGI & REANIMASI FK-UNSRAT MANADO / RSUP. MALALAYANG MANADO

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INTRAOCULAR PRESSURE DYNAMICS

PHYSIOLOGY INTRAOCULAR PRESSURE (IOP)

NORMAL IOP: 12 20 mmHg EYEHOLLOW SPHERE WITH RIGID WALLIF

SPHERE CONTENTS INCREASE IOP

TEMPORARY VARIATIONS IN PRESSUREWELL

TOLERATED IN NORMAL EYES

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CAUSE OF IOP
OBSTRUCTION OF AQUEOUS HUMOR OUTFLOW

(GLAUCOMA)

VOLUME OF BLOOD WITHIN THE GLOBE EXTREME CHANGES IN ARTERIAL BLOOD

VOLUME

A RISE IN VENOUS PRESSURE VENTILATION, ANY ANESTHETIC EVENT THAT

ALTERS THESE PARAMETERS (eg. LARYNGOSCOPY,

INTUBATION) 4/26/12

ALL THING CAN MARKED INCREASE IN INTRAOCULAR PRESSURE :

DECREASING SIZE OF GLOBE WITHOUT A

PROPORTIONAL CHANGE IN VOLUME OF ITS CONTENTS FITTED MASK

PRESSURE ON THE EYE FROM A TIGHTLY IMPROPER PRONE POSITIONING RETROBULBAR HEMORRHAGE
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WHEN THE GLOBE IS OPEN DURING CERTAIN

SURGICAL PROCEDURES OR AFTER TRAUMATIC PERFORATIONINTRAOCULARE PRESSURE APPROACHES ATMOSPHERIC PRESSRE INTRAOCULAR PRESSURE WILL TEND TO DECREASE INTRAOCULAR VOLUME (BY CAUSING DRAINAGE OF AQUEOUS OR EXTRUSION OF VITREOUS THROUGH THE WOUND)SERIOUS COMPLICATIONCAN PERMANENTLY WORSEN VISION

ANY FACTORS THAT NORMALLY INCREASES

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OCULOCARDIAC REFLEX (OCR)

TRACTION ON EXTRAOCULAR MUSCLES OR PRESSURE ON THE EYEBALL CAN ELICIT CARDIAC DYSRHYTMIAS RANGING FROM:
BRADYCARDIA VENTRICULAR ECTOPY TO SINUS ARREST, OR VENTRICULAR FIBRILLATION

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OCULOCARDIAC REFLEX (OCR)

THIS REFLEX CONSISTS OF A TRIGEMINAL

AFFERENT (V1) & A VAGAL EFFERENT PATHWAY UNDERGOING STRABISMUS SURGERY

OCR IS MOST COMMON IN PEDIATRIC PATIENTS CAN BE EVOKED IN ALL AGE GROUPS DURING :
CATARACT EXTRACTION ENUCLEATION RETINAL REPAIR

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OCULOCARDIAC REFLEX (OCR)

OFTEN HELPFUL PREVENTING OCR:

ANTICHOLINERGIC MEDICATION (IV ATROPIN OR GLYCOPYRROLATE IMMEDIATELY PRIOR TO SURGERY)

REMEMBER : ANTICHOLINERGIC MEDICATIONS

CAN BE HAZARDOUS IN ELDERLY PATIENTS (OFTEN WITH SOME DEGREE OF CORONARY ARTERY DISEASE) ALTERNATIVELY: RETROBULBAR BLOCKADE (BY SURGEON) OR DEEP INHALATIONAL ANESTHESIA BUT THESE PROCEDURE IMPOSE RISK OF THEIR OWN. 4/26/12

OCULOCARDIAC REFLEX (OCR)

MANAGEMENT OF OCR :
IMMEDIATE NOTIFICATION OF THE SURGEON TEMPORARY CESSATION OF SURGICAL

STIMULATION UNTIL HEART RATE INCREASES

CONFIRMATION OF ADEQUATE VENTILATION,

OXYGENATION, AND DEPTH OF ANESTHESIA

ADMINISTRATION OF IV ATROPINE (10g/kg) IF

THE CONDUCTION DISTURBANCE PERSISTS

IN RECALCITRANT EPISODESINFILTRATION

THE 4/26/12

RECTUS MUSCLES WITH LOCAL

EFFECT OF ANESTHETIC DRUGS ON INTRAOCULAR PRESSURE MOST ANESTHETIC DRUGS EITHER LOWER
OR HAVE NO EFFECT ON IOP
INHALATIONAL ANESTHETICS DECREASE IOP IN

PROPORTION TO THE DEPHT OF ANESTHESIA

INTRAVENOUS ANESTHETICS ALSO DECREASE

INTRAOCULAR PRESSURE, EXCEPTION IS KETAMINE RAISE ARTERIAL BLOOD PRESSURE IOP & DOESNT RELAX EXTRAOCULAR MUSCLES
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MULTIPLE CAUSES:

EFFECT OF ANESTHETIC DRUGS ON INTRAOCULAR PRESSURE HAS THE DECREASE OF ANESTHETIC

A DROP IN BLOOD PRESSURE REDUCES

CHOROIDAL VOLUME
RELAXATION OF THE EXTRAOCULAR

MUSCLES LOWER WALL TENSION AQUEOUS OUTFLOW

PUPILLARY CONSTRICTION FACILITATES

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EFFECT OF ANESTHETIC DRUGS ON INTRAOCULAR PRESSURE

TOPICALLY ADMINISTERED ANTICHOLINERGIC

DRUGS RESULT IN PUPILLARY DILATION (MYDRIASIS) MAY PRECIPITATE ANGLECLOSURE GLAUCOMA

PREMEDICATION DOSES OF SYSTEMICALLY

ADMINISTERED ATROPINE ARE NOT ASSOCIATED WITH INTRAOCULAR HYPERTENSION, HOWEVER IN PATIENTS WITH GLAUCOMA
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EFFECT OF ANESTHETIC DRUGS ON INTRAOCULAR PRESSURE

SUCCINYLCHOLINE INCREASES INTRAOCULAR

PRESSURE BY 5 10 mmHg FOR 5-10 MINUTES AFTER ADMINISTRATION, PRINCIPALLY THROUGH PROLONGED CONTRACTURE OF THE EXTRAOCULAR MUSCLES (NOT RECOMMENDED FOR GLAUCOMA PATIENTS)
A RISE IOP THROUGH AN OPEN SURGICAL OR

TRAUMATIC WOUND CAN CAUSE EXTRUSION OF OCULAR CONTENTS

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GENERAL ANESTHESIA FOR OPHTHALMIC SURGERY

INDICATION GENERAL ANESTHESIA :
IN UNCOOPERATIVE PATIENTS (EVEN SMALL

HEAD MOVEMENTS CAN PROVE DISASTROUS DURING MICROSURGERY)

LOCAL ANESTHESIA IS CONTRAINDICATED

FOR SURGICAL REASONS PREMEDICATION :

PATIENTS UNDERGOING EYE SURGERY
4/26/12 MAY BE APPREHENSIVE,ESPECIALLY IF

INDUCTION
THE CHOICE OF INDUCTION TECHNIQUES

FOR EYE SURGERY USUALLY DEPENDS MORE ON THE PATIENTS OTHER MEDICAL PROBLEMS THAN ON THE PATIENTS EYE DISEASE OR THE TYPE OF SURGERY CONTEMPLATED. RUPTURE GLOBETHE KEY TO INDUCING ANESTHESIA IN PATIENTS WITH OPEN EYE INJURY IS CONTROLLING INTRAOCULAR PRESSURE WITH A SMOOTH INDUCTION.

ONE EXCEPTION IS THE PATIENT WITH

KETAMIN IS CONTRA INDICATE

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INDUCTION
SPECIFICIALLY COUGHING DURING

INTUBATION MUST BE AVOIDED BY ACHIEVING A DEEP LEVEL OF ANESTHESIA & PROFOUND PRALYSIS
RESPONS IOP TO LARYNGOSCOPY &

ENDOTRACHEAL INTUBATION CAN BE BLUNTED BY PRIOR ADMINISTRATION OF INTRAVENOUS LIDOCAINE (1,5 mg/kg), OR FENTANYL (3-5 g/kg)

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NON DEPOLARIZING MUSCLE RELAXANT

DRUGS IS USED INSTEAD OF SUCCINYLCHOLINE (DEPOLARIZING MUSCL RELAX) BECAUSE SUCCINYL INFLUENCE ON IOP, EXCEPTION MOST PATIENTS WITH OPEN GLOBE INJURIES WHO HAVE FULL STOMACHS & REQUIRE A RAPID SEQUENCE INDUCTION TECHNIQUE
INHALATIONAL ANESTHETICS IS NO

PRO-BLEM DECREASE IOP IN PROPORTION TO THE DEPHT OF ANESTHESIA

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THE END OF LECTURE

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