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KLowe-Advanced Anes 2 (Rachel's Class) > Anesthesia for Ophthalmic Surgery > Flashcards

Anesthesia for Ophthalmic Surgery Flashcards

1
Q

Ocular anatomy–the eye has ___ layers…what are they?

A

The eye has 3 layers; they are sclera, uveal tract, retina

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2
Q

What is the middle layer of the eye?

A

Uveal tract

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3
Q

What is the outermost layer of the eye?

A

Sclera

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4
Q

The sclera is the ___ layer of the eye; it is ___, ____, ___ of the eye

A

The sclera is the outermost layer of the eye; it is tough, fibrous, white of the eye

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5
Q

What is the most anterior part of the eye?

A

Cornea

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6
Q

Most focus power is from the ___ of the cornea

A

Most focus power is from the curvature of the cornea

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7
Q

What is the middle layer of the eye and what are the (3) structures of this layer?

A

Middle layer = uveal tract

  • Choroid
  • Ciliary body
  • Iris
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8
Q

The choroid is a layer of ___, located ___ (anteriorly/posteriorly)

A

The choroid is a layer of blood vessels, located posteriorly

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9
Q

The ciliary body is located behind the ___, produces ___; it adjusts focus on lens by reducing tension on ___ fibers or ___ of the lens

A

The ciliary body is located behind the iris, produces aqueous humor; it adjusts focus on lens by reducing tension on suspension fibers or zonules of the lens

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10
Q

The iris is ___ and controls ___ entry

A

The iris is pigmented and controls light entry

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11
Q

Sympathetic stimulation = iris dilator muscle contracts, it causes pupil ___ (dilation/constriction) or ___sis

A

Sympathetic stimulation = iris dilator muscle contracts, it causes pupil dilation or mydriasis

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12
Q

Parasympathetic stimulation = iris sphincter muscles contract, causing pupillary ___ (dilation/constriction) or ___sis

A

Parasympathetic stimulation = iris sphincter muscles contract, causing pupillary constriction or miosis

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13
Q

Sympathetic stimulation = iris ___ (dilator/sphincter) muscle contracts, causing pupil ___ (dilation/constriction) or ___sis

A

Sympathetic stimulation = iris dilator muscle contracts, causing pupil dilation or mydriasis

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14
Q

Parasympathetic stimulation = iris ___ (dilator/sphincter) muscles contract, causing pupillary ___ (dilation/constriction) or ___sis

A

Parasympathetic stimulation = iris sphincter muscles contract, causing pupillary constriction or miosis

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15
Q

The retina is the ___most layer of the eye

A

The retina is the innermost layer of the eye

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16
Q

What receptors in the retina produce a neural signal when activated by light?

A

Photoreceptors

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17
Q

The retina ___ (does/does not) contain capillaries

A

The retina does NOT contain capillaries

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18
Q

Since the retina does not contain capillaries, what layer of the eye provides oxygen to the retina?

A

Choroid layer provides oxygen to the retina

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19
Q

Retinal detachment from the choroid compromises blood supply and is a major cause of vision loss–T/F?

A

True

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20
Q

The retina ends ___ mm behind the iris

A

The retina ends 4 mm behind the iris

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21
Q

What is the area between the limbus (edge) of the cornea and end of the retina?

A

Pars plana

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22
Q

The pars plana is a safe entry area for what procedures?

A

The pars plana is a safe entry area for vitrectomy procedures

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23
Q

The center of the eye is filled with ___ gel; it attaches to blood vessels and the ___ nerve; traction of vitreous on the retina causes ___

A

The center of the eye is filled with vitreous gel; it attaches to blood vessels and the optic nerve; traction of vitreous on the retina causes detachment

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24
Q

What are (3) indications for a vitrectomy?

A
  • Scarring
  • Bleeding
  • Opacification of vitreous
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25
Q

What is the term used to describe a variety of arrhythmias resulting from manipulation of the eye?

A

Ocular cardiac reflex (OCR)

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26
Q

Ocular cardiac reflex (OCR) manifests as ___cardia, ___ block, ventricular ___ and ___ (rarely)

A

Ocular cardiac reflex (OCR) manifests as bradycardia, AV block, ventricular ectopy and asystole (rarely)

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27
Q

OCR can occur with any stimulation of orbital contents, including lid and periosteum–T/F?

A

True

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28
Q

OCR is seen especially with traction of what particular muscle of the eye?

A

Medial rectus traction

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29
Q

OCR is ___ (from what cranial nerves does it originate?)*** Memorize

A

OCR is trigeminovagal

***Memorize

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30
Q

___ (afferent/efferent) impulses of the OCR originate in orbital contents (via long and short ciliary nerves)***Memorize

A

AFFERENT impulses of the OCR originate in orbital contents (via long and short ciliary nerves)

***Memorize

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31
Q

Afferent impulses from the OCR travel to the ___ ganglion, to the ___ division of the ___ nerve, to the ___ (sensory/motor) nucleus of the ___ nerve near the ___ ventricle, to visceral motor nuclei of the ___ nerve***Memorize

A

Afferent impulses from the OCR travel to the ciliary ganglion, to the ophthalmic division of the trigeminal nerve, to the sensory nucleus of the trigeminal nerve near the fourth ventricle, to visceral motor nuclei of the vagus nerve

***Memorize

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32
Q

Efferent limb of the OCR is ___ nerve to the ___***Memorize

A

Efferent limb of the OCR is vagus nerve to the heart

***Memorize

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33
Q

The OCR occurs more frequently in adults than peds–T/F?***Memorize

A

FALSE–OCR occurs more frequently in peds than adults

***Memorize

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34
Q

OCR may be seen during topical and general anesthesia–T/F?

A

True

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35
Q

OCR is seen ___ (more/less) during retrobulbar blocks

A

OCR is seen LESS during retrobulbar blocks

~Although orbital injections can stimulate reflex

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36
Q

OCR response is worsened by ___emia and ___carbia

A

OCR response is worsened by hypoxemia and hypercarbia

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37
Q

What should you do FIRST if OCR occurs?

A

Ask the surgeon to stop manipulation of the eye

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38
Q

Other steps in treatment of OCR–assess adequacy of ___; ___ localization or ___ anesthetic may help; for persistent bradycardia, treat with ___

A

Other steps in treatment of OCR–assess adequacy of ventilation; lidocaine localization or deepening anesthetic may help; for persistent bradycardia, treat with atropine

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39
Q

The OCR response becomes stronger with repeated stimulations–T/F?

A

FALSE–OCR response fatigues with repeated stimulations

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40
Q

Pretreatment with what (2) medications can be effective in preventing OCR? What patient populations should you consider this for?

A

Pretreatment with glyco or atropine can be effective in preventing OCR; consider this in patients with conduction block or on beta blocker

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41
Q

Blood supply to the eye is dependent on ___ perfusion pressure

A

Blood supply to the eye is dependent on intraocular perfusion pressure

MAP - IOP

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42
Q

___ (low/high) IOP impairs blood supply and optic nerve function

A

High IOP impairs blood supply and optic nerve function

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43
Q

Once the globe is open, factors increasing IOP can cause prolapse and loss of IO contents, resulting in permanent vision loss–T/F?

A

True

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44
Q

The globe is relatively ___ (compliant/non-compliant)

A

The globe is relatively NON-compliant

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45
Q

Volume in the globe is relatively fixed, except for ___ fluid and ___ blood volume

A

Volume in the globe is relatively fixed, except for aqueous fluid and choroid blood volume

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46
Q

What (2) quantities regulate IOP?

A
  • Aqueous fluid volume

- Choroid blood volume

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47
Q

Normal IOP = ___-___ mm Hg

A

Normal IOP = 10-22 mm Hg

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48
Q

IOP > ___ mm Hg is pathological

A

IOP > 25 mm Hg is pathological

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49
Q

Production of aqueous humor is facilitated by what enzyme?

A

Production of aqueous humor is facilitated by carbonic anhydrase

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50
Q

Increases in IOP leads to ocular ___tension, ___ changes (i.e.: atrophy of optic disc and nerve fibers, optic artery occlusion)

A

Increases in IOP leads to ocular hypertension, structural changes (i.e.: atrophy of optic disc and nerve fibers, optic artery occlusion)

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51
Q

Decreased IOP leads to fluid ___ (accumulation/removal) in the eye

A

Decreased IOP leads to fluid accumulation in the eye

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52
Q

Arterial pressure effect on IOP–sudden increases in BP ___ (increase/decrease) IOP; this effect is ___ (transient/long lasting) d/t drainage system

A

Sudden increases in BP increase IOP; this effect is transient d/t drainage system

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53
Q

Arterial pressure effect on IOP–sudden decreases in BP < ___ will drop IOP d/t loss of ___; systolic BP of ___ causes 3-4 torr decrease in IOP from decreased blood flow

A

Sudden decreases in BP < 90 will drop IOP d/t loss of autoregulation; systolic BP of 60 causes 3-4 torr decrease in IOP from decreased blood flow

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54
Q

Anesthetic events that increase BP = ___scopy, ___ation, ___ position

A

Anesthetic events that increase BP = laryngoscopy, intubation, Trendelenburg position

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55
Q

Increase in CVP ___ (increases/decreases) IOP, ___ (more/less) than increase in BP

A

Increase in CVP increases IOP, even more than increase in BP

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56
Q

What (4) activities may increase IOP d/t obstruction of drainage?

A
  • Coughing
  • Straining
  • Breathholding
  • Vomiting
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57
Q

IOP may increase up to ___x with coughing

A

IOP may increase up to 40x with coughing

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58
Q

Elevation of head ___ (increases/decreases) IOP; lowering head ___ (increases/decreases) IOP d/t mechanical drop

A

Elevation of head decreases IOP; lowering head increases IOP d/t mechanical drop

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59
Q

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

A

Direct pressure on the eye from compression in the prone position (coupled with lower systolic BP) has been indicated in postop vision loss

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60
Q

Decreased PaCO2 results in a fast ___ (rise/drop) in IOP from choroidal vaso___

A

Decreased PaCO2 results in a fast drop in IOP from choroidal vasoconstriction

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61
Q

Increased PaCO2 results in a slow ___ (increase/decrease) in IOP

A

Increased PaCO2 results in a slow increase in IOP

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62
Q

A fast respiratory rate may ___ (increase/decrease) IOP from insufficient ___ drainage

A

A fast respiratory rate may increase IOP from insufficient venous drainage

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63
Q

Metabolic acidosis ___ (increases/decreases) the choroid vessel volume and therefore ___ (increases/decreases) IOP

A

Metabolic acidosis decreases the choroid vessel volume and therefore decreases IOP

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64
Q

Metabolic alkalosis ___ (increases/decreases) the choroid vessel volume and therefore ___ (increases/decreases) IOP

A

Metabolic alkalosis increases the choroid vessel volume and therefore increases the IOP

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65
Q

Pressure to the globe from external forces may ___ (increase/decrease) IOP

A

Pressure to the globe from external forces may increase IOP

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66
Q

Most anesthetic drugs ___ (increase/decrease) or have ___ on IOP

A

Most anesthetic drugs decrease or have no effect on IOP

67
Q

Inhalation agents ___ (increase/decrease) IOP by ___ (increasing/decreasing) BP and thereby ___ (increasing/decreasing) choroidal volume; they ___ (relax/contract) extraocular muscles and ___ (increase/decrease) wall tension; pupil ___ (constriction/dilation) enables aqueous outflow

A

Inhalation agents decrease IOP by decreasing BP and thereby decreasing choroidal volume; they relax extraocular muscles and decrease wall tension; pupil constriction enables aqueous outflow

68
Q

IV agents propofol and thiopental ___ (increase/decrease) IOP

A

IV agents propofol and thiopental decrease IOP

69
Q

Ketamine may ___ (increase/decrease) IOP because it usually ___ (increases/decreases) BP and doesn’t ___ (relax/contract) extraocular muscles

A

Ketamine may increase IOP because it usually increases BP and doesn’t relax extraocular muscles

70
Q

What IV anesthetic is associated with myoclonus and thus may not be appropriate with an open globe?

A

Etomidate

71
Q

Opioids generally ___ (increase/decrease) IOP

A

Opioids generally decrease IOP

72
Q

Tracheal intubation will increase IOP if depth of anesthesia is inadequate, regardless of NMB used–T/F?

A

True

73
Q

Nondepolarizing NMB ___ (do/do not) alter IOP

A

Nondepolarizing NMB do NOT alter IOP

74
Q

Succinylcholine ___ (does/does not) increase IOP

A

Succinylcholine DOES increase IOP

75
Q

Succinylcholine increase in IOP starts within ___ minute; IOP increases ___-___ mm Hg for ___-___ minutes d/t prolonged contracture of extraocular muscle

A

Succinylcholine increase in IOP starts within 1 minute; IOP increase 5-10 mm Hg for 5-10 minutes d/t prolonged contracture of extraocular muscle

76
Q

Glaucoma patients have similar IOP response to succs as people without glaucoma–T/F?

A

True–the increase in IOP from succs administration is not exaggerated or prolonged in patients with glaucoma

77
Q

Succs can cause false measurements of IOP during exam under anesthesia for glaucoma patients–T/F?

A

True–measurements may be falsely elevated

78
Q

Rise in IOP from succs administration can cause extrusion of eye contents through an open surgical or traumatic wound–T/F?

A

True

79
Q

Prolonged contracture from succs administration alters forced duction test (test for extraocular muscle balance) for ___ minutes and may influence the type of strabismus surgery done

A

Prolonged contracture from succs administration alters forced duction test (test for extraocular muscle balance) for 20 minutes and may influence the type of strabismus surgery done

80
Q

What are (2) diuretics that can be used to decrease IOP?

A
  • Acetazolamide

- Mannitol

81
Q

Acetazolamide (Diamox) decreases ___ production by inhibiting ___ (what electrolyte?) pump, which decreases IOP; chronic use depletes what (3) electrolytes?

A

Acetazolamide (Diamox) decreases aqueous production by inhibiting sodium pump, which decreases IOP; chronic use depletes Na, K+, and bicarb

82
Q

What acid-base imbalance can result from chronic diamox use?

A

Metabolic acidosis

83
Q

Mannitol drops IOP by increasing ___ blood volume; max effect ___-___ minutes, returns to baseline in ___-___ hours

A

Mannitol drops IOP by increasing circulating blood volume; max effect 30-45 minutes, returns to baseline in 5-6 hours

84
Q

Topically applied eye drugs are absorbed at a rate ___ (slower/faster/intermediate) between subcutaneous and an IV injection

A

Topically applied eye drugs are absorbed at a rate INTERMEDIATE between subcutaneous and an IV injection

85
Q

Echothiophate is a topical anti___ drug that maintains ___ (mydriasis/miosis) to treat ___

A

Echothiophate is a topical anti cholinesterase drug that maintains miosis to treat glaucoma

86
Q

Systemic absorption of echothiophate leads to total inhibition of ___, resulting in prolonged ___ after succinylcholine administration

A

Systemic absorption of echothiophate leads to total inhibition of plasma cholinesterase, resulting in prolonged muscle paralysis after succinylcholine administration

87
Q

Echothiophate may predispose patients to ___-type (amide/ester) local toxicity

A

Echothiophate may predispose patients to ester-type local toxicity

88
Q

Echothiophate is ___ (short/long) acting

A

Echothiophate is LONG acting–takes 4-6 weeks for enzyme activity (plasma cholinesterase) to return to normal

89
Q

Phenylephrine is a/an ___ (alpha/beta) adrenergic agonist topically used to ___ (constrict/dilate) pupil

A

Phenylephrine is an alpha adrenergic agonist topically used to dilate pupil

90
Q

Pilocarpine and acetylcholine are ___ drugs (what class?) used to ___ (dilate/constrict) the pupil; ___cardia and acute ___ have been reported

A

Pilocarpine and acetylcholine are cholinergic drugs used to constrict the pupil; bradycardia and acute bronchospasm have been reported

91
Q

What is a topical beta blocker used to treat glaucoma?

A

Timolol

92
Q

Systemic absorption of timolol can cause ___cardia, ___spasm, and ___ exacerbation

A

Systemic absorption of timolol can cause bradycardia, bronchospasm, and CHF exacerbation

93
Q

Flomax (tamsulosin hydrochloride) has selective ___ (alpha/beta) ___ (agonistic/antagonistic) properties; it binds the iris ___ (constrictor/dilator) muscles, affecting iris ___ and complicates ___ surgery

A

Flomax (tamsulosin hydrochloride) has selective alpha antagonistic properties; it binds the iris dilator muscles, affecting iris dilation and complicates cataract surgery

94
Q

In those taking flomax, the iris remains floppy even after ___-___ days off therapy

A

In those taking flomax, the iris remains floppy even after 7-28 days off therapy

95
Q

What is the most common elderly surgery?

A

Eye surgery

96
Q

Pre-op evaluation for eye surgery–severe HTN leads to postop complications; stage 3 is systolic > ___ or diastolic > ___; reschedule sustained stage 3 HTN client until ___ weeks of antiHTN treatment

A

stage 3 HTN is systolic > 180 or diastolic > 110; reschedule sustained stage 3 HTN client until 2 weeks of antiHTN treatment

97
Q

Pre-op eval for eye surgery–diabetics–check fasting glucose and use insulin to maintain BS ___-___

A

Check fasting glucose and use insulin to maintain BS 150-250

98
Q

Pre-op eval for eye surgery–critical results–Na less than ___, greater than ___; K less than ___, greater than ___

A

Na less than 120, greater than 158; K less than 2.2, greater than 6.2

99
Q

Pre-op eval for eye surgery–critical results–BUN greater than ___

A

BUN greater than 104

100
Q

Pre-op eval for eye surgery–critical results–serum glucose less than ___, greater than ___

A

serum glucose less than 46, greater than 484

101
Q

Pre-op eval for eye surgery–critical results–Hct < ___% or > ___%; Hgb < ___ or > ___

A

Hct < 18% or > 61%; Hgb < 6.6 or > 19.9

102
Q

Pre-op eval for eye surgery–hemorrhage potential is serious in ___ and ___ surgery; intermediate in ___, ___, and ___ transplant; least in ___ surgery

A

Hemorrhage potential is serious in orbital and oculoplastic surgery; intermediate in vitreoretinal, glaucoma, and corneal transplant; least in cataract surgery

103
Q

Most agree that it is safe to do cataract surgery with patient on warfarin–T/F?

A

True

104
Q

Facial nerve block is utilized for eye surgery when complete akinesis of ___ is desired

A

Facial nerve block is utilized for eye surgery when complete akinesis of eyelid is desired (can’t squeeze eye, can’t squint)

105
Q

Facial nerve blocks ___ muscle

A

Facial nerve blocks orbicularis oculi muscle

106
Q

What is a major complication of Van Lint, Atkinson, or O’Brien blocks?

A

Subcutaneous hemorrhage

107
Q

Nadbath Rehman blocks entire trunk of facial nerve; expect lower facial droop postop for several hours; injection is close to what (2) cranial nerves?

A

Nadbath Rehman blocks entire trunk of facial nerve; expect lower facial droop postop for several hours; injection is close to VAGUS and GLOSSOPHARYNGEAL nerves

108
Q

Nadbath Rehman block is associated with ___ paralysis, ___spasm, dys___, and ___ distress

A

Nadbath Rehman block is associated with vocal cord paralysis, bronchospasm, dysphasia, and respiratory distress

109
Q

Retrobulbar block involves injection of local anesthetic within the ___

A

Retrobulbar block involves injection of local anesthetic within the muscle cone

110
Q

What is added to retrobulbar block to speed tissue penetration?

A

Hyaluronidase (Hydase, Amphadase, Vitrase, Hylenex)

111
Q

Retrobulbar block produces anesthesia of the ___, akinesia of the ___ muscle, and ___tony (drop in IOP from relaxation of ___ muscle and ___ [increased/decreased] production of aqueous humor)

A

Retrobulbar block produces anesthesia of the globe, akinesia of the extraocular muscle, and hypotony (drop in IOP from relaxation of extraocular muscle and decreased production of aqueous humor)

112
Q

What muscle may NOT be blocked by a retrobulbar block? Why?

A

Superior rectus muscle because it runs outside the muscle cone

113
Q

How can you tell if the superior rectus muscle was NOT blocked by a retrobulbar block?

A

Intorsion on downward gaze

114
Q

What is the most common complication of retrobulbar block?

A

Retrobulbar hemorrhage–watch for OCR

115
Q

What are (2) signs of retrobulbar hemorrhage?

A
  • Proptosis (downward displacement)

- Subconjunctival ecchymosis

116
Q

Monitoring of ___ is mandatory if retrobulbar hemorrhage occurs

A

Monitoring of IOP is mandatory if retrobulbar hemorrhage occurs

117
Q

If there is no elevation in IOP from retrobulbar hemorrhage, then surgery may proceed–T/F?

A

True

118
Q

Retrobulbar hemorrhage–bleeding outside muscle cone is seen as ___ without ___

A

Retrobulbar hemorrhage–bleeding outside muscle cone is seen as subconjunctival ecchymosis without proptosis

119
Q

RBB–intravascular injection ___ (can/cannot) occur with negative aspiration

A

RBB–intravascular injection CAN occur with negative aspiration

120
Q

RBB–IV injection is usually of little consequence–T/F?

A

True because it is such a small dose

121
Q

RBB–arterial injection leads to high brain levels via retrograde flow in internal carotid artery; CNS ___ and ___ are possible, but are usually ___ d/t redistribution

A

RBB–arterial injection leads to high brain levels via retrograde flow in internal carotid artery; CNS excitation and seizure are possible, but are usually transient d/t redistribution

122
Q

RBB complications–injection into optic nerve sheath (which is continuous with the ___ space) leads to…contralateral ___; ___ation; ___ arrest (occurs within ___ minutes, resolves within ___ hour); vascular ___ from depressant effect on the medulla (total ___)

A

RBB complications–injection into optic nerve sheath (which is continuous with the subarachnoid space) leads to…contralateral amaurosis (complete lack of vision), obtundation, respiratory arrest (occurs within 20 minutes, resolves within 1 hour), vascular collapse from depressant effect on the medulla (total spinal)

123
Q

Other RBB complications–___ nerve damage; ocular ___ with retinal ___ and vitreous ___; postop ___ from anesthetic myotoxicity (occurs with what local?)

A

Other RBB complications–optic nerve damage; ocular perforation with retinal detachment and vitreous hemorrhage; postop strabismus from anesthetic myotoxicity (occurs with bupivacaine)

124
Q

RBB complication–postop strabismus from anesthetic myotoxicity = vertical ___ vision that occurs day after surgery, worsening over ___ months; occurs d/t tight ___ rectus muscle

A

RBB complication–postop strabismus from anesthetic myotoxicity = vertical double vision that occurs day after surgery, worsening over 2 months; occurs d/t tight inferior rectus muscle

125
Q

What are contraindications for RBB?–___ disorders; extreme ___; ___ eye injury

A

contraindications for RBB–bleeding disorders (d/t risk of RB hemorrhage); extreme myopia (longer globe is more at risk of perforation); open eye injury (b/c pressure of fluid behind eye may force intraocular contents out through wound)

126
Q

Peribulbar blockade is ___ (more/less) safe than retrobulbar block

A

Peribulbar blockade is more safe than retrobulbar block

127
Q

Compared to RBB, peribulbar blockade involves multiple injections made around eye without entering the ___

A

Compared to RBB, peribulbar blockade involves multiple injections made around eye without entering the muscular cone

128
Q

Peribulbar blockade has a ___ (shorter/longer) onset time compared to RBB

A

Peribulbar blockade has a longer onset time compared to RBB (9 to 12 minutes)

129
Q

Peribulbar block offers ___ (more/less) complete akinesia

A

Peribulbar block offers less complete akinesis

130
Q

Globe perforations have been reported with peribulbar blocks–T/F?

A

True

131
Q

There is a/an ___ (increased/decreased) likelihood of ecchymosis with peribulbar blocks than RBB

A

There is an increased likelihood of ecchymosis with peribulbar blocks than RBB

132
Q

Benefits of sub-tenon’s block–local anesthetic ___ into retrobulbar space; avoid use of ___; complications ___ (more/less) than RBB and peribulbar block

A

Benefits of sub-tenon’s block–local anesthetic diffuses into retrobulbar space; avoid use of sharp needle; complications less than RBB and peribulbar block

133
Q

What (2) local anesthetics are used topically for eye surgery?

A
  • Tetracaine 0.5%

- Lidocaine 4%

134
Q

How is the topical given?–two drops of ___ given initially, followed by ___ more doses of ___ or ___ q ___ minutes just before surgery

A

Two drops of tetracaine given initially, followed by 3 more doses of tetracaine or lidocaine q 5 minutes just before surgery

135
Q

Neither general nor regional anesthesia have shown to be safer for eye surgery–T/F?

A

True

136
Q

What is the only anesthetic option for ruptured globe?

A

General ETT is the only choice for ruptured globe

137
Q

Emesis from vagal stimulation, especially after ___ surgery, is common

A

Emesis from vagal stimulation, especially after strabismus surgery, is common

138
Q

Important to aggressively prevent and treat ___ for eye surgery patients undergoing general anesthesia

A

Important to aggressively prevent and treat nausea for eye surgery patients undergoing general anesthesia

139
Q

Severe pain post op is unusual after eye surgery, except for what (3) types of eye surgery?

A
  • Scleral buckling
  • Enucleation
  • Ruptured globe repair
140
Q

Severe pain post-op may indicate IO ___, corneal ___, or other complication

A

Severe pain post-op may indicate IO hypertension, corneal abrasion, or other complication

141
Q

In certain vitreoretinal procedures, an air bubble is injected into the eye to tamponade the detached ___ to the globe

A

In certain vitreoretinal procedures, an air bubble is injected into the eye to tamponade the detached retina to the globe

142
Q

Should nitrous be used in vitreoretinal procedures where an air bubble is used? Why?

A

NO–because nitrous diffuses and causes air bubble expansion, with potential for IOP increase

143
Q

N2O should be d/c’ed ___ minutes before placement of sulfur hexafluoride and avoided for ___ to ___ days after

A

N2O should be d/c’ed 15 minutes before placement of sulfur hexafluoride and avoided for 7 to 10 days after

144
Q

Another vitreal air agent, perfluoropropane (C3F6), persists for ___

A

Another vitreal air agent, perfluoropropane (C3F6), persists for weeks

145
Q

How long should N2O be avoided if perfluoropropane (C3F6) is instilled?

A

Avoid N2O for 1 month after instillation of the agent

146
Q

Open globe surgeries are usually ___

A

Open globe surgeries are usually emergent, full stomachs

147
Q

Succs can be safely used for induction of anesthesia for open globe injury–T/F?

A

True–no actual case reports of further eye injury when succs is used

Controversy d/t increase in IOP from succs; actual intubation would probably cause more of an increase in IOP than use of succs if patient is not adequately anesthetized

148
Q

In extraocular procedures, the globe ___ (is/is not) open

A

In extraocular procedures, the globe is NOT open

149
Q

What is critical for extraocular procedures?

A

Decreased bleeding; IOP not as critical

150
Q

Extraocular procedures typically have ___ (more/less) pain postop d/t tissue handling and swelling

A

Extraocular procedures typically have more pain postop d/t tissue handling and swelling

151
Q

What extraocular surgery is done to resection (shorten) and recession (lengthen) the opposite muscle?

A

Strabismus surgery

152
Q

16% of all eye surgeries are related to a muscle disorder–T/F?

A

True

153
Q

What drug should be avoided in strabismus surgery?

A

Succs d/t prolonged response

154
Q

Eyelid surgery–usually done ___; ptosis raises suspicion for ___ disease

A

Eyelid surgery is usually done local; ptosis raises suspicion for neuromuscular disease

155
Q

What is most important consideration for lacrimal apparatus surgery?

A

Suction pharynx well!!!

Defectively drained excess tears will drain back into the pharynx

156
Q

Enucleation is done for what (4) reasons?

A
  • Tumor
  • Trauma
  • Cancer
  • Painful eye
157
Q

Watch for ___ during enucleation

A

Watch for OCR during enucleation

158
Q

What drug is usually avoided for eye surgeries? Why?

A

Ketamine d/t nystagmus

159
Q

Retinal detachment is a/an ___ (intra/extra) ocular procedure

A

Retinal detachment is an extraocular procedure

160
Q

Vitrectomy is a/an ___ (intra/extra) ocular procedure

A

Vitrectomy is an intraocular procedure

161
Q

During vitrectomy, diseased vitreous is removed and replaced by ___; ___ (soft/hard) eye desired; ___ placed

A

During vitrectomy, diseased vitreous is removed and replaced by balanced salt solution; soft eye desired; air gas bubble placed

162
Q

For retinal detachment/vitreal surgery, patient may be placed in a specific position to enhance reattachment–T/F?

A

True

163
Q

If gas bubble is used, ___ precautions must be used

A

If gas bubble is used, nitrous precautions must be used

KLowe-Advanced Anes 2 (Rachel's Class) (16 decks)

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