Anaesthesia for paediatric eye surgery

This page is under construction, converting the originally formatted pdf from the WFSA site with wiki embellishments.

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

Summary
Children require general  anaesthesia for  ophthalmic procedures/ surgery, but  can  generally be managed as  day cases.
The oculocardiac  reflex may be induced  during eye surgery and  risks provoking  dangerous bradycardias. Prevent these by  premedicating with  anticholinergic agents.
Postoperative nausea  and vomiting is  common after eye  surgery in children.

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. 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.

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.