Summary of Talk
Ophthalmic Anaesthetics
Intra-ocular pressure/EUA
Eye trauma
Strabismus surgery
GA in Dental Procedures
Paediatric Ophthalmic
Procedures
Usually under general anaethesia
Usually day procedures:
EUA
Lacimal duct probing
Strabismus correction
Ophthalmic Medications
-blockers (Timolol) glaucoma
Systemic Effect Bradycardia (refractory to Atropine); bronchospasm in asthmatics
Oculocardic Reflex
Seen in up to 60% undergoing strabismus surgery
Afferent innervations
from the ophthalmic
portion of the trigeminal
nerve, relays via the sensory
nucleus in the 4th ventricle,
with the efferent impulse in
the Vagus nerve
Commonly due to traction on the medial rectus muscle
Atropine (20mcg/kg) or glycopyrrolate (10mcg/kg)
Sevo Vs Halothane
Atrac Vs Roc
High CO2 - consider controlled ventilation
Ketamine:
IM (5-10mg/kg)
IV induction (1-2mg/kg)
May slightly increase IOP
Give with Atropine/Glycopyrrolate - ***contraversial
Sevofluorane:
Decreases IOP, restrict to 5% or less
Measure IOP quickly
Ideally no airway equipment is used:
Masks compress the eyes and the patient must be deep to
accept an LMA
Nasolacrimal Ducts
Blocked nasolacrimal ducts require probing and irrigation
Usually present early with tearing
Strabismus Correction
Most common paediatric eye surgery
Seen in 3-5% of the population
Extubate deeply
A peribulbar block is good at reducing
PONV and pain
Risk of globe perforation
Sub-Tenon block is very effective
Topical analgesics
Tetracaine
GA Dental Procedures
Pre-assessment:
History and exam. Facial swelling?
Is mouth opening limited?
Induction:
IV or inhalational
Antisialogogue agents may help:
Atropine/Glycopyrrolate
Maintenance:
Nasal mask Vs ETT Vs Nasal ETT
GA Dental Procedures
Pharyngeal packs Ferguson pack with McKesson mouth
prop to maintain opening
LMA for longer procedures
ETT more extensive issues
ie Wisdom teeth removal
Nasal airways
Post-induction:
ETT with NMB and a short-acting opioid
Then controlled with volatile or target-controlled Propofol
Post-op compliations of GA
Minor cough, N&V, headache
Major complete respiratory obstruction, neck injury
Bleeding Tonsil
Perioperative considerations
Keep the child warm, hypothermia
promotes coagulopathy
NG tube after haemostasis
Extubate awake in left lateral, head
down
OR
Tonsil position
A bolster placed under the chest in the
lateral position
Head is below the level of the chest
Bleeding Tonsil
Post-operative Care:
Close monitoring in a well-lit area
Keep Hb over 8g/dl provided no more
bleeding
Should remain
in hospital for
at least 24 hours
post bleed
Thank-you
Any questions?