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anesthesia for eye surgery Flashcards

1
Q

3 layers of sphere

A

Sclera
Uveal tract (middle layer)
Retina

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2
Q

Ocular sphere diameter

A

24mm

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3
Q

Sclera is the ________ layer.
Tough, _______, ______ of the eye.
________ most anterior part (most focus power is from curvature of ______)

A

outermost,
fibrous,
white,
Cornea, Cornea

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4
Q

3 structures of the middle layer (Uveal tract)

A

Choroid,
Ciliary body,
Iris,

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5
Q

layer of blood vessels, located posteriorly

A

choroid

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6
Q

behind iris, produces aqueous humor

A

ciliary

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7
Q

Pigmented, controls light entry

A

Iris

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8
Q

Retina contains _____, no ______, and ____ ____

A

photoreceptors,
no capillaries,
pars plana

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9
Q

what provides oxygen to retina if no capillaries?

A

choroid layer (detachment from choroid compromises blood supply and is major cause of vision loss)

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10
Q

Area between limbus (edge) of cornea and end of retina

A 
pars plana
(safe entry area for vitrectomy procedures)
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11
Q

center of eye is filled with _____ gel, attaches to blood vessels and _____ nerve,

A

vitreous,

optic

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12
Q

Traction of ______ on _____ causes detachment

A

vitreous on retina

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13
Q

Vitrectomy treats

A

scarring, bleeding, or opacification of vitreous

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14
Q

responsible for movement of eye upward

A

superior rectus muscle,

and inferior oblique roates the eyeball on its horizontal axis allowing “rolling eyes”

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15
Q

responsible for movement of eye downward

A

inferior rectus

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16
Q

all ocular muscles originate in the orbital apex around the annulus of ___, except for the ______ ______

A

Zinn, inferior oblique

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17
Q

Term used to describe a variety of arrhythmias resulting from manipulation of the eye

A

Ocular Cardiac Reflex (OCR)

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18
Q

OCR manifests as

A

bradycardia, AV block, ventricular ectopy and asystole (rarely)

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19
Q

T/F: Ocular cardiac reflex can occur with any stimulation of orbital contents including lid and periosteum

A

True

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20
Q

OCR is seen especially with ____ _____ traction

A

medial rectus

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21
Q

Ocular cardiac reflex is

A

trigeminovagal

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22
Q

OCR Afferent impulses originate in ____ contents (via _____ and _____ _____ nerves

A

orbital

long and short ciliary nerves

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23
Q

to _____ _____
to _____ division of the _____ nerve
to _____ nucleus of _____ nerve near ______ ventricle,
to ________ motor nuclei of the ______

A

ciliary ganglion,
opthalmic division of the trigeminal nerve,
to sensory nucleus of trigeminal nerve near fourth ventricle,
to visceral motor nuclei of the vagus

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24
Q

_____ limb is _____ nerve to the heart

A

efferent,

vagus

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25
Q

Ocular cardiac reflex is more frequent in peds or adults?

A

peds

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26
Q

OCR response worsened by -xemia and -carbia

A

hypoxemia and hypercarbia

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27
Q

OCR and retrobulbar blocks?

A

OCR seen less although orbital injections can stimulate

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28
Q

Treatment of Ocular Cardiac Reflex

A

ask surgeon to stop manipulation,
assess adequacy of ventilation,
lidocaine localization or deepening anesthetic may help,
for persistent bradycardia, treat with atropine,
response fatigues with repeated stimulations,
pretreatment with glyco or atropine can be effective-consider in patients with conduction block or on BB rx

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29
Q

Calculate intraocular perfusion pressure

A

MAP less IOP

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30
Q

Normal IOP

A

10-22mmHg

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31
Q

What regulates IOP?

A

quantity of aqueous and blood volume

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32
Q

Volume is relatively fixed except for ____ fluid and ______ blood volume

A

aqueous ,

choroid

33
Q

Anesthetic events that increase BP

A

laryngoscopy and intubation,

trendelenburg position

34
Q

IOP may increase up to _____ with coughing

A

40x

35
Q

Direct pressure on the eye from compression in the ____ position (coupled with lower SBP) has been indicated in postop vision loss.

A

prone,

keep MAP above 75 usually

36
Q

_______PaCO2 results in a fast drop in IOP from ______ vasoconstriction,
Although ____ respiratory rate may increase IOP from insufficient _____ drainage

A

Decreased,
choroidial,
a fast,
venous

37
Q

Increased PaCO2 results in a ____ increase in IOP

A

slow

38
Q

metabolic _____ decreases the choroid vessel volume and therefore IOP

A

acidosis

39
Q

metabolic ______ increases the choroid volume and the IOP

A

alkalosis

40
Q

most anesthetic drugs and inhalation agents _____ IOP

A

drop

41
Q

Ketamine and IOP

A

may increase as it usually raises BP and doesnt relax extraocular muscles

42
Q

Etomidate and IOP

A

associated with myoclonus (10-60%) and may not be appropriate with an open globe

43
Q

Succs and IOP

A

starts within 1min and increases 5-10mmHg for 5-10 minutes

44
Q

Carbonic anhydrase inhibitor: Acetazolamide (Diamox) _____ IOP. Chronic use depletes __, ___, and ____ leading to metabolic ______

A

decreases,
K, Na, and bicarb,
metabolic acidosis

45
Q

Osmotic diuretic used intraop to decrease IOP

A

Mannitol

46
Q

Topical anticholinesterase drug maintain miosis to Rx glaucoma

A

Echothiophate

47
Q

Systemic absorption of echothiophate leads to

A

total inhibition of plasma cholinesterase prolonging succs

48
Q

alpha adrenergic agonist topically used to dilate pupil

A

phenylepherine

49
Q

Cholinergic drugs used to constrict pupil

A

pilocarpine and acetylcholine (bradycardia and acute bronchospasm have been reported)

50
Q

Topical beta blocker used for glaucoma

A

Timolol-systemic absoprtion can cause bradycarda, bronchospasm, and CHF exacerbation.

51
Q

what drug needs held for cataract surgery?

A

flomax- has selective alphad antagonistic properties. It binds the iris dilator muscles, affecting iris dilation and complicates cataract surgery even after 7-28days off therapy

52
Q

Most common elderly surgery

A

Eye surgery

53
Q

Sustained stage 3 htn SBP>180 or DBP>110 reschedule for cataract?

A

yes until two weeks of antihtn treatment

54
Q

Hemorrhage potential
serious-
intermediate-
least-

A

serious-obrital and oculoplastic surgery
intermediate-vitreoretinal, glaucoma, corneal transplant
least-cataract surgery (most agree safe to do cataract with pt on warfarin

55
Q

facial nerve blocks

A

blocks orbicular oculi muscle (cant squeeze eye, cant squint)
Van lint,
Atkinson,
O’Brien

56
Q

Blocks entire trunk of facial nerve

A

Nadbath Rehman

57
Q

Nadbath Rehman Block expect _____. Close to vagus and glossopharyngeal nerve so associated with

A

lower facial droop postop for several hours.

vocal cord paralysis, laryngospasm, dysphasia, and resp distress

58
Q

Injection of local anesthetic within the muscle cone

A

Retrobulbar Block, produces anesthesia of the globe, akinesia of the extraocular muscle and hypotony

59
Q

Most common complication of Retrobulbar block

A

Retrobulbar hemorrhage

60
Q

Retrobulbar block injection into optic nerve sheath (contiuous with subarachnoid space) leads to

A

contralateral amaurosis (complete lack of vision),
obtundation,
resp arrest (occurs w/n 20min resolves w/n an hour),
vascular collapse from depressant effect on the medulla (total spinal)

61
Q

Retrobulbar block ____ nerve damage, ocular ______ w/ ______ detachment and ______ hemorrhage

A

opitc,
perforation,
retinal,
vitreous

62
Q

RBB postop Strabismus from anesthetic myotoxicity,

vertical _____ vision day after surgery, worsening over 2 months

A

double

63
Q

How can retorbulbar block lead to open eye injury

A

pressure of fluid behind eye may force intraocular contents out through wound

64
Q

peribulbar block ___ approach, multiple injections around eye w/o entering muscular _____

A

safer,
cone,
increased likelihood of ecchymosis

65
Q

Block with less complications than retrobulbar block and peribulbar block

A

Sub-Tenon’s Block( Tenon’s fascia surrounds globe and extraocular muscles)

66
Q

Topical avoids complication of block, disadvantages are potential for pt ______

A

movement

67
Q

only choice of anesthesia for globe rupture

A

general ETT

68
Q

How is the head positioned for eye surgery usually?

A

away form anesthesia, RAE tube

69
Q

What can vagal stimulation cause especially after strabismus surgery?

A

emesis

70
Q

Severe pain may indicate

A

IO hypertension, corneal abrasion or other complication

71
Q

When should N2O be d/c before placement of sulfur hexaflouride and avoided how longer after?

A

15minutes before and avoided 7 to 10 days after

72
Q

How long should N2O be avoided after the vitreal air agent, perfluoropropane

A

for One Month

73
Q

What anesthetic agent taught not to use for open globe injury?

A

Succs d/t increase in IOP

74
Q

Is strabismus surgery intra- or extraocular?

A

Extraocular

75
Q

Patients who have strabismus surgery typically have related muscle disorder. Anesthetic consideration?

A

Malignant hyperthermia, RAE tube, nausea, avoid succs d/t prolonged response

76
Q

Anesthetic consideration for lacrimal apparatus surgery?

A

suction pharynx well

77
Q

What are enucleations done for?

A

tumor, trauma, CA, painful eye

78
Q

Why is ketamine usually avoided in eye surgery?

A

nystagmus

79
Q

Anesthesia management for retinal detachment and vitreal surgery

A

Retrobulbar block or general ett(rae or LMA.

Potential for gas buble use

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