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Advanced Principles of Anesthesia - 931 > Eyes > Flashcards

Eyes Flashcards

1
Q

Where is the anterior chamber?

A

between the cornea and iris

filled with aqueous humor produced by ciliary body

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2
Q

where is the posterior chamber?

A

between the iris and lens

contains lens

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3
Q

What is strabismus?

A

ocular misalignment

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4
Q

how many muscles are on each eye? and what are they?

A

6
superior, inferior, medial, lateral rectus
superior and inferior oblique

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5
Q

Concerns with strabismus surgery?

A

Pain
N&V
Emergence Delirium (opthalamic + short)
Occulocardiac reflex

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6
Q

How do we treat pain from strabismus surgery?

A

tylenol 15 mg/kg
tetracaine prior to prep
toradol 0.5 mg/kg
fentanyl PRN

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7
Q

Decadron and Zogran dosing for pediatrics

A

0.1 mg/kg

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8
Q

What is the cause of oculocardiac reflex

A

Muscle pulled = bradycardia
Lots of pressure on eye = bradycardia
AFFERENT - Trigeminal (5)
EFFERENT - Vagus (10)

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9
Q

What is the first thing you do for OCR

A

Tell them to stop
Atropine (10 mcg/kg) or Glycopyrrolate
Local anesthetic (very rare)

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10
Q

When should you pretreat with anticholinergics?

A

Down’s Syndrome

Adult w/resting HR 40

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11
Q

What is the laryngospasm dosing

A

Succs 4 mg/kg IM and Atropine 0.2 mg/kg

Succ 2 mg/kg IV (reality, give 10 mg)

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12
Q

Exam under Anesthesia?

A

Done on their own, or in conjugation w/another surgery
Duration: 1 minute - 2 hours
Used to evaluate kids that can’t tolerate eye exams in the clinic, muscle tightness prior to strabismus, cancer treatment, etc.

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13
Q

What is Bells Phenomenon?

A

When the eyeballs move upward and outward when forcefully closed. It is what the body uses to protect the cornea.

Most often seen during speculum insertion & traction on the muscles

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14
Q

What amount of MAC is needed to abolish Bell’s?

A

1.8

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15
Q

EUA exam tips

A

Lots of gas, then no gas, then lots. LMA. Fluorescein.

usually just need tylenol

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16
Q

What is Fluoresceein?

A

bright yellow dye used to see retina images and leaks around corneal surgical sites

5 - 7 mg/kg (push like adenosine)

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17
Q

What is an ERG?

A

Electroretinograms
These are done prior to an EUA to assess the actual cones and rods and how functional they are.

Put them to sleep, cover eyes for 20 minutes, just wait.

TIVA bby

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18
Q

What is retinoblastoma?

A

Occular cancer of retina affecting kids < 4 (usually). There is a tumor in the eye (1:3 are bilateral). Genetic? Sometimes. Usually, no family hx. Frequently from Huntersville, NC.

Curable… but increased risk of other cancers later in life..

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19
Q

Retinoblastoma sx in peds

A

Start as an EUA - may or may not need laser or cryotherapy once the tumor is seen

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20
Q

Retinoblastoma sx in adults

A

MAC + block

Radiation pellets

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21
Q

Amblyopia

A

lazy eye
affects kids 0 - 7
eye patch, dilation drops

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22
Q

cataracts

A

in kids - GA + tube b/c they are intense

may or may not need a lens replacement

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23
Q

Chalazion

A

sty removal

quick + LMA

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24
Q

Premed dosing

A

versed 0.5 mg/kg PO 15 - 30 m before surgery

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25
Q

Emergence Delirium RF

A

eyee
< 1 hour
rapid wakeup
sevo

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26
Q

When does precedex peak?

A

20 m

remember, it loweers BP

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27
Q

Retina case

A

TUBE + PARLYZE

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28
Q

Open Globe

A

emergent ( surgery w/i 12 - 24 h)
severity can range from a small laceration (few stitches) to full retina exploration

definition: full thickness defect in the cornea or sclera

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29
Q

Anesthesia Considerations for an Open Globe

A
  • Dehydrated patient
  • GA + ETT
  • Oral Rae (unless > 6 ft, b/c an 8.0 won’t be long enough)
  • Probs the only eye case that needs antibiotics
30
Q

ABX for Open Globe

A

Vanc

Zosyn

31
Q

Corneal Transplant Melts

A

Corneal transplant has rejected or suture has become undone… leaving an opening to the eye

32
Q

Corneal Transplant Melts Anesthesia

A

GA - if patient coughs, the eye contents will extrude
LMA vs ETT (depends on severity of eye)
Don’t block these patients

33
Q

Canaliculi Repair

A

Usually from dog bites
NPO status is good, so use LMA
quick procedure

34
Q

Endopthalmitis

A

Infection of the tissues or fluids INSIDE the eyeball
Retina surgeon does a vitrectomy to remove infected vitreous gel and inject abx into the eye
Block or no block depending on extent of infection

35
Q

Endopthalmitis Anesthesia

A

GA - ETT (retina cases)
Lasts 3 - 4 hours

Potentially MAC (PBB/RBB)

36
Q

When do you use paralytics

A

Only if coughing would cause a major problem (i.e. retina or open globe)

37
Q

RBBB

A
  • less volume
  • more chance of hemorrhage b/c anesthetic is placed inside muscle cone
  • spread of LA into CSF = death in 5 m
  • better akinesia for the surgeon
38
Q

PBB

A
  • may require an injection above & below the orbit
  • can be patchy (may need to ask fo more local)
  • safer
39
Q

Mac/Cutdown

A

aka topical anesthetic
2 - 6 tetracaine drops (in divided doses 1 - 2 minutes apart) prior to prep

eye can only hold 1 mL at a time

40
Q

extensive opeen globe case

A

consider a foley!!!

41
Q

Diamox (Acetazolamide)

A

carbonic anhydrase inhibitor used to lower pressure in the eye by lowering the amount of aqueous humor production in front of eye

Dose: 250 - 500 mg
Mix w/NS
Give at end of the case
DONT GIVE WITH ANOTHER DRUG ESP. ZOFRAN
CONTRAINDICATED W/ SULFA

just drops with kids

42
Q

what is the leading cause of new cases of blindness among adults

A

DM (age 20 - 74)

Cataracts (worldwide)

43
Q

What is the annulus of Zinn?

A

tissue ring around the optic nerve

good landmark for point of insertion of many muscles

44
Q

What is the volume of each adult orbit?

A

30 mL

an orbit contains an eyeball (globe) + other structures

45
Q

Opthalmic artery

A

first branch of internal carotid, passes into orbit through optic canal (lies inferolateral to optic nerve)

46
Q

What is the visual axis?

A

Optic axis

Imaginary line from the midpoint of cornea to midpoint of retina/macula

47
Q

What is axial length?

A

A measurement of the visual axis.

Measured preoperatively to determine appropriate intraocular lens.

48
Q

Normal axial length

A

23 - 23.5 mm

49
Q

Hyperopia

A

Farsighted

< 22 mm

50
Q

Myopia

A

Nearsighted
> 24 mm

increased chance of puncturing globe

51
Q

What is in the posterior segment?

A

vitreous humor, retina, macula, root of optic nerve

52
Q

Name CN involved in vision

A

2-7, 10

2 = optic
3 = occulomotor
4 = trochlear
5 = trigeminal
6 = abducens
7 = facial
10 = vagus
53
Q

OPTIC N

A

CN 2
Orbital portion of the optic nerve is 25 - 30 mm long
Travels posteriorly within the muscle cone
4 mm diameter; outgrowth of brain
Covered by meninges
Central retinal artery & vein surround the nerve

54
Q

Occulomotor N muscles

A

Inneervates superior rectus, inferior rectus, medial rectus, inferior oblique, and levator

55
Q

CN III PSNS vs SNS

A

PSNS to ciliary ganglion & pupil constriction

SNS to pupil dilation

56
Q

Trochlear nerve

A

motor fibers to superior oblique muscle

57
Q

what is unique about cn 4

A

enters orbit from outside muscle cone

58
Q

CN 5

A

sensory + motor

forms trigeminal ganglion

59
Q

three divisions of trigeminal nerve

A

opthalmic (lacrimal, frontal, nasociliary)
maxillary
mandibular

60
Q

abducens n

A

CN 6 to lateral rectus

61
Q

facial nerve

A

motor to facial muscles

62
Q

vagus

A

efferent pathway for OCR

63
Q

superior rectus

A

supraduction (3)

64
Q

inferior rectus

A

infraduction (3)

65
Q

medial rectus

A

adduction (3)

66
Q

lateral rectus

A

abduction (6)

67
Q

superior oblique

A

intorsion, depression (4)

68
Q

inferior oblique

A

extorsion, elevation (3)

69
Q

what raises the upper eyelids

A

LEVATOR

70
Q

what contracts the eyelid

A

orbicular

71
Q

what raises ICP

A

squinting, contraction of levator or orbicular

Advanced Principles of Anesthesia - 931 (3 decks)

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