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AAN2 > Class 1 Eye Surgery > Flashcards

Class 1 Eye Surgery Flashcards

1
Q

What are the 3 layers of the eye wall.

A

Sclera = Outer
Uveal tract = Middle
Retina = Inner

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2
Q

Name the some features of the sclera?

A
  • Tough, fibrous, white of the eye

- Contains cornea (most anterior part of eye)

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3
Q

Most focus power of the eye comes form what?

A

-Curvature of the cornea

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4
Q

Name the 3 structures of the uveal tract (middle layer) of the eye? And what do they do?

A
  • Choroid = Layer of blood vessels, provides O2
  • Ciliary Body = Produces aqueous humor, controls size of iris
  • Iris = Pigmented, controls light entry
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5
Q

What do sympathetic stimulation do to the iris? Parasympathetic?

A
  • Dilates (mydriasis)

- Constriction (Miosis)

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6
Q

What is the safe area for vitrectomy procedures?

A

-Pars plana

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7
Q

What 2 things are found in the retina?

A
  • Photoreceptors (produces neural signal)

- Pars plana

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8
Q

What 3 things are treated with a virtrectomy?

A

-Scarring, bleeding, opacification

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9
Q

What term is used to describe arrhythmias that result from manipulation of the eye?

A

Ocular Cardiac Reflex

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10
Q

Ocular cardiac reflex can occur with stimulation of any part of the eye, but especially what?

A

-Medial rectus traction

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11
Q

Ocular cardiac reflex can manifest as what 4 things?

A
  • Bradycardia
  • AV block
  • Ventricular ectopy
  • asystole
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12
Q

What type of reflex is the ocular cardiac reflex?

A

-trigeminal-vagal

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13
Q

How to treat OCR?

A
  • Ask surgeon to stop manipulation
  • Assess ventilation
  • Lidocaine local or deepen anesthetic
  • Pretreat with robinol or atropine
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14
Q

What is normal IOP? What is pathological?

A
  • 10-22 mmhg

- >25

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15
Q

Production of aqueous humor is facilitated by what enzyme?

A

-Carbonic anhydrase

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16
Q

Sudden increases in BP _______ IOP, but this soon ________ due to the ________ system

A
  • Increases
  • Dissipates
  • Drainage
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17
Q

Sudden drops in BP will also drop IOP due to loss of what?

A

-Auto regulation

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18
Q

What increases IOP more severely, an increase in CVP or BP?

A

-CVP

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19
Q

Coughing, straining, breathholding, and vomiting ______ IOP by _________ of drainage.

A
  • Increases

- Obstruction

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20
Q

Decreases in CO2 does what to IOP and why?

A
  • Fast drop in IOP

- choroidial vasoconstriction

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21
Q

Increases in CO2 results in what?

A

-Slow increase in IOP

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22
Q

A fast respiratory rate may increase IOP from what?

A

insufficient venous drainage

23
Q

Metabolic acidosis ______ the choroid vessel volume and therefore ________ IOP

A
  • Decreases

- Decreases

24
Q

Metabolic alkalosis ______the choroid volume and _______ IOP

A
  • Increases

- Increases

25
Q

How do inhalation agents decrease IOP?

A
  • Lower BP
  • relax extraoccular muscles (lowers wall tension)
  • Pupil constriction (enables aqueous outflow)
26
Q

How do the following agents affect IOP? Propofol? Ketamine? Succs? Opioids? Non-depolarizer NMR?

A
  • Propofol = Decreases
  • Ketamine = Increases
  • Succs = Increase
  • Opioids = decrease
  • Nondepolarizers = Does not alter
27
Q

Etomidate is associated with what? and therefore is not appropriate for what?

A
  • Myoclonus

- Open globe procedures

28
Q

How does Succs effect eye surgery?

A
  • Inaccurate measurements of IOP
  • Increase IOP can push eye contents through wounds
  • Alters duction test (influence type of strabismus surgery)
29
Q

What is an example of a carbonic anhydrase inhibitor? and how does it effect IOP?

A
  • Acetazolamide

- Decrease aqueous humor production therefore decreases IOP

30
Q

Which osmotic diuretic is used to decrease intraop IOP?

A

Mannitol

31
Q

At what rate are topical eye drugs absorbed?

A

-Between SubQ and IV

32
Q

Ecothiopate is what kind of drug used for what?

A
  • Topical anitcholinesterase

- Maintain miosis as glaucoma RX

33
Q

Systemic absorption of ecothiopate may do what?

A

-Inhibition of plasma cholinesterase (prolong succs)
-Dispose to ester-type local toxicity
-

34
Q

What type of drug is phenylepherine and how is it used in eye surgery?

A
  • Topical Alpha adrenergic agonist

- Dilate pupil

35
Q

What 2 cholinergic drugs used to constrict pupil.

A
  • Pilocarpine

- Acetylcholine

36
Q

What is timolol?

A

-Topical beta blocker used for glaucoma

37
Q

What drug binds to iris dilator muscles causing a floppy iris?

A

-Flomax

38
Q

What are the critical results for Na? K? Urea nitrogen? Serum Glucose?

A
  • Na < 120 >158
  • K < 2.8 >6.2
  • BUN 484
39
Q

Stage 3 HTN is what? and what should be done with the patient?

A
  • Systolic >180, Diastolic >110

- Reschedule for 2 after start of anti-HTN drug

40
Q

What eye procedures are considered serious potential for hemorrhage? Intermediate? Least?

A
  • Serious = Orbital and oculoplastic surgery
  • Intermediate = vitreoretinal, glaucoma, corneal transplant
  • Least = Cataract
41
Q

What are the requirements for eye surgery?

A
  • Akinesia of eye
  • Anti anxiety
  • Profound anesthesia at surgical site
42
Q

Name 3 facial nerver blocks? When are they used? What muscle does it block? What is the major complication?

A
  • Van Lint, Atkinson, O’Brien
  • Complete akinesis of eyelid is requires
  • Orbicular oculi
  • SubQ Hemorrhage
43
Q

What block blocks the entire trunk of the facial nerve? What can be expected? What is associated?

A
  • Nadbath
  • Facial droop
  • Vocal cord paralysis, Laryngospasms, dysphasis, resp. distress
44
Q

What does the retrobulbar block do?

A
  • Anesthesia of the globe
  • Akinesia of extraocular muscles
  • Hypotony (drop in IOP)
45
Q

What muscle is not affected by a RBB? and how is that evidenced?

A
  • Superior rectus

- downward gaze

46
Q

What are the complications of RBB?

A
  • Retrobulbar hemorrhage (most common)
  • Proptosis (downward displacemnt)
  • Subconjunctival ecchymosis
  • Optic verve damage
  • Ocular perforation
  • Post op strbismus
  • Myopia (nearsightedness)
47
Q

Why is a RBB into the optic nerve so dangerous? What can it cause?

A
  • Continues into the subarachnoid space
  • Amaurosis (lack of vision)
  • Obtundation
  • Respiratory arrest
  • Vascular collapse
48
Q

Why is a peribulbar block safer than a RBB? Disadvantages?

A
  • Less hemorrhage, Multiple injections w/o entering cone

- Longer onset, less akinesia, increased ecchymosis

49
Q

How does sub-tenons block work? What needs to be avoided?

A
  • Sub-tenons fascia surrounds globe and extraocular muscles
  • LA diffuses into retrobulbar space
  • Sharp needles
50
Q

Vagal stimulation may result in what? And what procedure is this most common?

A
  • Emesis

- Strabismus surgery

51
Q

What eye procedures are associated with post op pain?

A

-Scleral buckling, enucleation, ruptured globe repair

52
Q

In certain vitreoretinal procedures, an air bubble is injected into the eye, what should be DC’d 15 minutes prior to bubble placement and why? How long after sulfur hexaflouride bubble should N2O be avoided?

A
  • N2O
  • Causes bubble expansion and increase IOP
  • 7-10 days
53
Q

How long should N2O be avoided after perfluoropropane bubble?

A

1 month

AAN2 (11 decks)

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