Anaesthesia for paediatric eye surgery - Revision history

WikiSysop at 19:24, 16 January 2025

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	=== Glaucoma ===		=== Glaucoma ===
	~~T he~~ pressure within the eye is maintained through a balance between the production of aqueous humor, primarily by the ciliary body in the posterior chamber, and drainage via the trabecular network to the canal of Schlem in the anterior chamber.		The pressure within the eye is maintained through a balance between the production of aqueous humor, primarily by the ciliary body in the posterior chamber, and drainage via the trabecular network to the canal of Schlem in the anterior chamber.

	In glaucoma the normal IOP of 10–20mmHg is elevated so that capillary blood flow to the optic nerve is reduced, which compromises the function of the optic nerve.		In glaucoma the normal IOP of 10–20mmHg is elevated so that capillary blood flow to the optic nerve is reduced, which compromises the function of the optic nerve.

	~~T he~~ causes of glaucoma are varied:		The causes of glaucoma are varied:

	* Primary congenital glaucoma is caused by a failure of the development of the trabecular network, reducing the drainage of aqueous humour. It is bilateral in 75% of cases and has a prevalence of 1:10000 births. There is a male to female ratio of 35%: 65% and it is more common in children below the age of 3 years.		* Primary congenital glaucoma is caused by a failure of the development of the trabecular network, reducing the drainage of aqueous humour. It is bilateral in 75% of cases and has a prevalence of 1:10000 births. There is a male to female ratio of 35%: 65% and it is more common in children below the age of 3 years.

WikiSysop at 19:22, 16 January 2025

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 ''Originally from Update in Anaesthesia | www.wfsahq.org/resources/update-in-anaesthesia''
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 Airway management should be tailored to the procedure. For measurement of intraocular pressure (IOP), spontaneous respiration via a facemask should be used, as intubation will raise the intraocular pressure. For simple procedures such as examination under anaesthesia (EUA) it may be more convenient to maintain spontaneous respiration through a reinforced laryngeal mask airway (LMA), particularly where a sterile field is required.
-The reinforced LMA may be used in older children for most eye procedures. It is possible to use controlled ventilation with muscle relaxants, and coughing is reduced at the end of the surgery. Intraocular surgery requires a still eye with low intraocular pressure.  The airway is best managed by intubation with paralysis and controlled ventilation.
+The reinforced LMA may be used in older children for most eye procedures. It is possible to use controlled ventilation with muscle relaxants, and coughing is reduced at the end of the surgery.
-Similarly, eye surgery in very young children is best managed with intubation and controlled ventilation to ensure a secure airway. Access to the airway will be restricted during the surgery so it is important to secure the tracheal tube firmly. A preformed south facing RAE tube is ideal, but this may be too long in neonates; a reinforced flexible tracheal tube (ETT) may be preferable in this situation.
+Intraocular surgery requires a still eye with low intraocular pressure.  The airway is best managed by intubation with paralysis and controlled ventilation.
 ==== Maintenance of anaesthesia ====
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 Children who exhibit the oculocardiac reflex are more likely to develop PONV<ref>Allen LE, Sudesh S, Sandramouli S, Cooper G, et al. The association   between the oculocardiac reflex and postoperative vomiting in   children undergoing strabismus surgery. Eye. 1998; 12: 193 – 96.</ref> and should receive an antiemetic during anaesthesia.
 === Extubation and emergence from anaesthesia ===

WikiSysop at 19:13, 16 January 2025

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WikiSysop at 18:43, 16 January 2025

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WikiSysop at 18:12, 16 January 2025

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	=== Preoperative Considerations ===		=== Preoperative Considerations ===
	Most children presenting for eye surgery are healthy, ASA I or II and may be managed as day cases. A small number have underlying conditions, often of a chromosomal or metabolic nature, which pose more specific anaesthetic challenges.1,2 Examples of these are described in appendix 1.		Most children presenting for eye surgery are healthy, ASA I or II and may be managed as day cases. A small number have underlying conditions, often of a chromosomal or metabolic nature, which pose more specific anaesthetic challenges.<ref>James I. Anaesthesia for paediatric eye surgery. Continuing Education in Anaesthesia, Critical Care and Pain 2008; 8: 5 – 10.</ref><ref name=":0">Morrison A. Ophthalmology, plastics, oncology, radiology, thoracic, and dental surgery. In: Doyle E, eds. Paediatric Anaesthesia. Oxford, Oxford University Press. 2007: 298 – 307.</ref> Examples of these are described in appendix 1.

	=== Ophthalmic Medications ===		=== Ophthalmic Medications ===
	Many children requiring eye surgery receive eye drops. Knowledge of commonly used drugs and potential side effects is useful (See table 1). Medications may be absorbed through the pharyngeal mucosa via the nasolacrimal ducts to cause systemic effects, although this is rarely a significant problem.2,3,4		Many children requiring eye surgery receive eye drops. Knowledge of commonly used drugs and potential side effects is useful (See table 1). Medications may be absorbed through the pharyngeal mucosa via the nasolacrimal ducts to cause systemic effects, although this is rarely a significant problem.<ref name=":0" /><ref>Steward DJ, Lerman J. Manual of Pediatric Anesthesia. Churchill Livingstone, 2001: 225 – 33.</ref><ref>BNF for children. Notes on drugs and preparations: Eye. BMJ group, RPS Publishing. 2008: 606 – 27.</ref>

	=== Anaesthetic Considerations ===		=== Anaesthetic Considerations ===

WikiSysop at 18:07, 16 January 2025

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	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''


			Reprinted with revisions from: Stuart G. Anaesthesia for paediatric eye surgery. Anaesthesia Tutorial of the Week 144 (2009)

			Grant Stuart Correspondence email: grant.stuart@gosh.nhs.uk
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			!Summary
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			* Children require general anaesthesia for ophthalmic procedures/ surgery, but can generally be managed as day cases.
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			* The oculocardiac reflex may be induced during eye surgery and risks provoking dangerous bradycardias. Prevent these by premedicating with anticholinergic agents.
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			* Postoperative nausea and vomiting is common after eye surgery in children.
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			== Introduction ==
			Unlike adults, children requiring eye surgery do not tolerate sedation or local anaesthetic techniques and therefore almost always require general anaesthesia. T his update will present a general review of the principles of anaesthesia for children undergoing eye surgery and a description of anaesthesia for some specific procedures.

			== General Principles of Anaesthesia For Paediatric Eye Surgery ==

			=== Preoperative Considerations ===
			Most children presenting for eye surgery are healthy, ASA I or II and may be managed as day cases. A small number have underlying conditions, often of a chromosomal or metabolic nature, which pose more specific anaesthetic challenges.1,2 Examples of these are described in appendix 1.

			=== Ophthalmic Medications ===
			Many children requiring eye surgery receive eye drops. Knowledge of commonly used drugs and potential side effects is useful (See table 1). Medications may be absorbed through the pharyngeal mucosa via the nasolacrimal ducts to cause systemic effects, although this is rarely a significant problem.2,3,4

			=== Anaesthetic Considerations ===

			==== Premedication and induction of anaesthesia ====
			The decision to premedicate the child and the choice of induction technique, intravenous (IV) or inhalational, should be tailored to the needs of the child and to the preferences of the anaesthetist. Children with visual impairment should be handled in a careful and sensitive manner.

			==== Airway management ====
			Airway management should be tailored to the procedure. For measurement of intraocular pressure (IOP), spontaneous respiration via a facemask should be used, as intubation will raise the intraocular pressure. For simple procedures such as examination under anaesthesia (EUA) it may be more convenient to maintain spontaneous respiration through a reinforced laryngeal mask airway (LMA), particularly where a sterile field is required.

			The reinforced LMA may be used in older children for most eye procedures. It is possible to use controlled ventilation with muscle relaxants, and coughing is reduced at the end of the surgery. Intraocular surgery requires a still eye with low intraocular pressure. The airway is best managed by intubation with paralysis and controlled ventilation.

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''Originally from Update in Anaesthesia | www.wfsahq.org/resources/update-in-anaesthesia''