- Paediatric eye surgery
- Indications
- Examination of the eye
- Fundoscopy
- Measurement of IOP
- Lids/orbital surgery
- Meibomian cysts
- Ptosis surgery
- Tarsorrhaphy
- Nasolacrimal surgery
- Eye surgery
- Strabismus surgery
- Corneal surgery
- Enucleation
- Laser surgery/cryotherapy
- Intraoccular procedures
- Trabeculotomy
- Vitrectomy
- VR surgery
- Pre-op assessment
- Usually ASA 1/2
- May have developmental delay or challenging behaviour
- Look out for syndromes or chromosomal associations
- Craniofacial syndromes
- Mucopolysaccharoidosis
- Cranial synostosis disorders
- Neuro-occulo-cutaneous diseases
- Homocysteinuria, Marfan's
- Bacterial endocarditis considerations if have associated structural cardiac lesion
- Mainly limited to those having nasolacrimal surgery
- ROP
- Still common despite advances in neonatal care
- Risks
- BW <1500g
- <31 wks gestational age
- Blood vessels grow in the retina and graded 1-5 with increasing severity
- High grades (3+) at risk of retinal detachment
- May need cryotherapy which is painful and requires opiates
- Requires early treatment and so other disorders are common eg bronchopulmonary dysplasia
- Emergency surgery
- Probably ok to use sux in a penetrating eye injury if regurgitation is an issue
- Anaesthesia
- FM or LMA for simple examination
- LMA ok for short procedures eg laser surgery
- For intra-ocular procedures, paralysis and IPPV/ETT or IPPV via an LMA is most reliable
- If the GA is solely for measuring IOP some anaesthetists actually use ketamine so as not mask the reduction of IOP assd with other agents. Others use Inhalational induction but limit sevo to 5%. Measurement of IOP is best performed before instrumentation of the airway
- Syringing/probing of the nasolacrimal duct
- Short procedure usually done under LMA
- Remember endocarditis prophylaxis
- Aspirate oropharynx before removal of LMA
- Dacrocystorhinotomy has more potential for blood loss so use of an ETT is advocated
- Strabismus
- High incidence of PONV
- Possible association with MH
- Common procedure and done as daycase
- Botulinum is occasionally used under EMG so avoid NMBDs if being used
- Adjustable suture may be used by the surgeon for manipulation post op under LA
- Associated with occulocardiac reflex
- Occurs in 60%
- Usually resolves when stimulus is removed
- Commoner when medial rectus manipulated
- Associated with PONV and may be causative
- Avoid by giving 20μcg/kg atropine at induction
- Seen less with sevoflurane than halothane
- Seen with rocuronium > atracurium > pancuronium
- PONV
- 0.1mg/kg ondansetron
- 0.1mg/kg dexamaethasone
- Multimodal approach is needed in these cases
- Avoid nitrous and opiates
- Analgesia
- Sub-Tenon's
- Peribulbar
- Diclofenac 0.1% eye drops or oxybutracaine 0.4%
- NSAIDs and paracetamol
- Enucleation/evisceration
- Painful
- Can evoke the occulocardiac reflex
- CEACCP
Link:ceaccp.oxfordjournals.org/content/8/1/5.full.pdf?sid=dc96bc68-0cd9-4630-be69-af9cbdd3e121