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NU 758 Adv Principles > Eye > Flashcards

Eye Flashcards

1
Q

what kind of eye drop is phospholine iodide

A

miosis-inducing anticholinesterase

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2
Q

what anesthetic drug does phospholine iodide interfere with & what is the effect

A

succ, prolongs the effects from profound interference with succ metabolism

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3
Q

what is a concern with phenylephrine eye drops

A

systemic absorption causing transient malignant HTN

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4
Q

systemic effect of acetylcholine eye drops

A

bronchospasm, bradycardia, hypoTN

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5
Q

systemic effect of timolol eye drops

A

atropine resistant bradycardia, bronchospasm, CHF exacerbation, possible myasthenia gravis exacerbation

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6
Q

systemic effect of atropine eye drops

A

-central anticholinergic symdrome: delirium, fever, flushing, xerostomia, anhidrosis)
-blurry vision (cycloplegia, photophobia)

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7
Q

how to prevent systemic absorption of eye drops (3)

A
  1. close eyes for 60 sec after placing
  2. avoid blinking
  3. apply pressure on medial canthus after closing the eye
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8
Q

3 types of blocks used for eye surgery

A

sub-tendon
retrobulbar
peribulbar

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9
Q

does topical anesthesia prevent surgical pain? akinesia?

A

no/minimal and no

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10
Q

what eye surgery is topical used for (2)

A

cataracts (2% lido drops or gel) or vitreoretinal (but usually requires sub-tendon block as well, +/- GA)

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11
Q

what blocks produce eye akinesia

A

peribulbar & retrobulbar, sub-tendon to a lesser extent

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12
Q

what cranial nerves are blocked by retro/peribulbar blocks

A

3, 4, 5, 6, 7
(3, 4, 6 = EOM, 5 opthalmic sensory, 7 ocular reflexes)

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13
Q

what technique is the most common/effective, causing profound anesthesia and akinesia of the eye and eyelids

A

ocular regional needle block (includes peri/retrobulbar injection)

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14
Q

do true muscle cones exist (esp in the posterior portion of the orbit)?

A

no

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15
Q

compare RB and PB blocks

A

-RB: traditionally presumed to be more effective but carries a higher risk of complication
-Both have similar success rates
-PB is preferable

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16
Q

retrobulbar block complications (3)

A

optic nerve injury
brainstem anesthesia
RB hemorrhage

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17
Q

s/s or RB hemorrhage

A
  1. subconjunctival or eyelid ecchymosis
  2. increasing protosis (bleeding causing the eye to move forward)
  3. increased IOP, pressure on optic nerve, vessels, and globe
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18
Q

does analgesia or akinesia occur first with an eye block

A

analgesia then akinesia

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19
Q

can you guarantee analgesia with akinesia

A

no. it may be assumed but not guaranteed w an akinetic eye

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20
Q

when can you assess effectiveness of a RB block? PB block?

A

RB in 2 min
PB in 10 min
& observe for eye movement in all 4 quadrants

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21
Q

normal IOP range

A

10-22mmHg

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22
Q

what is the normal variation in IOP

A

2-5mmHg

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23
Q

risks of sustained increase in IOP (4)

A

acute glaucoma
retinal ischemia
hemorrhage
permanent vision loss

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24
Q

does externally compression on the globe impact IOP

A

minimally

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25
Q

factors that can lead to increased IOP (4)

A

venous congestion
straining
coughing
retching

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26
Q

how much can straining, coughing, or retching during intubation increase IOP

A

40mmHg

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27
Q

what can happen if pt coughs while the globe is open

A

permanent damage or blindness

28
Q

2 respiratory factors that increase IOP

A

hypoxemia & hypoventilation

29
Q

2 factors that decrease IOP

A

hyperventilation & hypothermia

30
Q

indications for GA for eye procedures (7)

A

-peds
-pt lack of cooperation
-severe claustrophobia
-inability to communicate
-inability to lie flat
-open-eye injuries
- >2h surgery time

31
Q

disadvantages to GA for eye sx (6)

A

-n/a
-rethcing/bucking
-increased IOP
-aspiration
-complications due to comorbidities
-time/expense

32
Q

NPO practice with regional anes & eye sx

A

varies…some practitioners allow light meals on the day or and some say strict NPO

33
Q

sedation + regional for eye procedure…what’s a concern if the patient is sleeping

A

sleeping patients may snore and have sudden head movements disrupting the surgeon

34
Q

what is the goal of sedation with regional eye blocks

A

reduce patient anxiety, enhance cooperation, reduce discomfort of the block

35
Q

if patient is awake, you need to tell them to warn you before they…

A

cough or clear their throat

36
Q

3 benefits to the use of peripheral nerve blocks for eye procedures

A

less pain, PONV and decreased PACU time

37
Q

whats a choroidal hemorrhage and what are the consequences

A

-a vessel in the vascular choroidal layer ruptures and bleeds into the closed cavity –> increase in IOP & risk of expulsion of eye contents unless the eye is quickly closed

38
Q

if onset of PONV occurs suddenly at home what is the problem

A

increased IOP (not anesthesia related)

39
Q

what are causes of PONV w eye surgery?

A

from anesthetic meds OR increased IOP and ocular pain

40
Q

2 induction agents that lower IOP

A

prop and etomidate

41
Q

can you use NMBD for eye surgery and why

A

yes– nondepol are preferred, they can decrease IOP

42
Q

how can you blunt rise in IOP during DL

A

IV lido 1.5-2mg/kg, 1-1.5min before DL

43
Q

2 other risks associated with eye surgery (not eye related)

A

MH and PONV

44
Q

can you use LMAs for eye surgery?

A

yes
no NMBD needed
less risk of coughing in the awake patient

45
Q

effect of succ on IOP

A

increases IOP transiently

46
Q

can you use succ for eye surgery? what are 2 risks?

A

yes it can be safely used but 1) it can cause a sustained contracture of extra-ocular eye muscles (risk of expulsion of intraocular contents) and 2) sustained contraction can interfere with the surgeons forced duction testing

47
Q

eye trauma: 5 anesthesia considerations

A
  1. use slight reverse T
  2. avoid increased in IOP
  3. consider modified RSI w large dose of roc (1mg/kg – per ppt)
  4. treat HTN and increased IOP from DL with lido and opioids
  5. consider regional
48
Q

what is the greatest cause of complication during regional and GA with eye surgery

A

patient movement

49
Q

risk of intraarterial injection of LA with regional blocks…what can happen?

A

-grand mal seizures have occured with lido & lido-bupiv combos
-can occur with less than toxic doses by direct arterial injection, causing retrograde flow to cerebral circulation

50
Q

7 tips to prevent intravascular injection of LA w/ eye blocks

A
  1. choose least vascular areas for needle placement
  2. avoid deep orbital injections
  3. avoid supranasal gaze
  4. insert needle slowly
  5. aspirate before injection
  6. dont inject against resistance
  7. avoid rapid/forceful injections
51
Q

Retrobulbar hemorrhage: arterial vs venous

A

arterial is rapid onset w/ ecchymosis of the eyelid and orbit
venous is slow

52
Q

treatment option of RB hemorrhage that does not self-resolve

A

lateral canthotomy

53
Q

what is the most devastating complication with globe puncture

A

ocular explosion (Rare) – the globe can burst apart from intraocular pressure exerted by the LA injection

54
Q

2 RF for globe puncture

A
  1. multiple orbital injections
  2. patient mvmt
55
Q

s/s of globe puncture (5) (** on her slide)

A
  1. increased resistance to injection
  2. immediate dilation and paralysis of the pupil
  3. rapid increase in IOP w/ edematous cornea**
  4. hypotony of the globe
  5. intraocular hemorrhage**
56
Q

what is the oculo-cardiac reflex

A

trigeminal-vagal reflex generated by pressure on the globe, orbital structures, or traction on the extra-ocular eye muscles

57
Q

afferent and efferent pathways of the oculo-cardiac reflex

A

afferent = trigeminal (A5)
efferent = vagus to cardioinhibitory center
(E10)

58
Q

what hemodynamic effect will you see with oculo-cardiac reflex

A

bradycardia

59
Q

first treatment step if oculo-cardiac reflex triggered

A

ask the surgeon to release traction (then you can treat with agent to increase HR if needed)

60
Q

warning signs of retinal detachment

A
  1. sudden appearance of floaters/flashes of light (one or both eyes)
  2. blurry/gradually reduced side/peripheral vision
  3. curtain-like shadow over one’s visual field
61
Q

onset of retinal detachment

A

spontaneously during activity/straining or trauma related

62
Q

most common cause of post-op eye pain

A

corneal abrasion

63
Q

2 treatment options for retinal detachment

A

scleral buckle or vitrectomy

64
Q

what anesthetic agent should you avoid using with retinal detachment repair

A

N2O: it can increase the size and pressure of the tamponading agent used w surgical repair.
Volatile anesthetics are safe to use.

65
Q

increased IOP due to a tight face mask, DL/ET intubation, or due to coughing/bucking, can cause…

A

extrusion of globe contents & jeopardize vision

NU 758 Adv Principles (5 decks)

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