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Justin Lyle Cards > Ophthalmology > Flashcards

Ophthalmology Flashcards

1
Q

what is the oculocardiac reflex

A
  1. pressure is put on the globe of the eye/traction on the extraocular muscles 2. causes bradycardia and dysrhythmias (via trigeminal [afferent] and vagus [efferent] nerves)
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2
Q

under which type of anesthesia can the oculocardiac reflex be induced?

A
  1. local 2. regional 3. general
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3
Q

what is the anticipated outcome of the oculocardiac reflex with continued stimuli?

A

the reflex arc will fatuge

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4
Q

which anesthetic technique can induce the oculocardiac reflex, but can also be protective from future stimuli

A

regional (blocks)

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5
Q

anesthetic management of the oculocardiac reflex

A
  1. release pressure/stop eye manipulation 2. atropine 10 mcg/kg (could also use glycopyrrolate)
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6
Q

oculocardiac reflex with complete vagal block, up to ___________ mg of atropine could be given

A

3-Feb

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7
Q

T/F: you can prevent oculocardiac reflex with opthalamic surgery when pre-treat with atropine and/or retrobulbar block

A

false; pre-tx with atropine and/or retrobulbar block is not helpful

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8
Q

if oculocardiac reflex is eliciting refractory bradycardia, how can you tx it?

A

infiltrate the rectus muscle with local anesthetic

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9
Q

what is normal intraocular pressure

A

10-20 mmHg

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10
Q

what are the most important determinants of intraocular pressure?

A

balance between (1) production, (2) drainage, (3) and reabsorption of the aqueous humor

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11
Q

what are the determinants of intraocular pressure

A
  1. aqueous humor dynamics 2. changes in choroidal blood volume 3. central venous pressure 4. extraocular muscle tone
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12
Q

which anesthetic agents decrease IOP?

A
  1. volatile inhalation agents 2. N2O 3. propofol 4. Benzodiazepines 5. opioids 6. Rocuronium
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13
Q

which anesthetic agents increase IOP?

A
  1. succinylcholine 2. ketamine
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14
Q

what is the most common form of glaucoma

A

open angle

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15
Q

_________________ is d/t a gradual blockage of outflow of the aqueous humor d/t sclerosis of the trabecular tissue

A

open angle glaucoma

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16
Q

what are the medication goals in tx open angle glaucoma

A
  1. enhanced drainage of aqueous humor 2. reduced production of aqueous humor
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17
Q

cholinergics and sympatholytics are used to tx ________________ glaucoma

A

open angle

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18
Q

outflow of open angle glaucoma is improved with medications that cause the pupil to _________________

A

constrict (miosis)

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19
Q

atropine drops –> mydriasis is contrindacted in which type of glaucoma

A

closed angle

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20
Q

which glaucoma type can appear suddenly and is often painful, often an ocular emergency

A

closed angle glaucoma

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21
Q

____________________ glaucoma is d/t obstruction from the posterior chamber to the anterior chamber

A

closed angle

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22
Q

_______________ angle glaucoma worsens with mydriasis

A

closed angle

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23
Q

T/F: you can use drugs like neostigmine to reverse NMB in pts with closed angle glaucoma

A

true, normally you would avoid drugs that cause mydriasis, but IV NMB reversals are okay

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24
Q

beta 2 stimulation on aqueous humor production?

A

B2 stimulation increases aqueous humor production

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25
Q

Muscarinc stimulation on aqueous humor production

A

improves the outflow of aqueous humor

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26
Q

how can the anesthesia provider prevent corneal abrasion from occurring while under anesthesia

A
  1. ensuring the eyelids are closed and secured with tape 2. muscle relaxant use with ocular surgery 3. ensure padding and periodic checks of the eye if the patient is in the prone position
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27
Q

when would you expect a patient to get an intraocular injection of perfluropropane or sulfur hexafluoride?

A

retinal detachment procedures

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28
Q

anesthetic considerations for a patient who has had an intraocular injection of perfluropropane or sulfur hexafluoride

A
  1. N20 must be stopped at least 15 min prior to injection 2. avoid N2O for 10 days after sulfur hexafluoride 3. N2O must be avoided for 30 days after perfluoropropane injection
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29
Q

why would a scleral buckling procedure be performed?

A

retinal detachment

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30
Q

how is a scleral buckling procedure performed?

A
  1. silicone band sewn around the sclera, creates a dimple on the eye wall 2. buckle is secured under conjunctiva, moving wall of eye closer to the detached retina 3. laser therapy creates permanent adhesion
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31
Q

the __________________ score is used to evaluate criteria for discharging patient from ambulatory center to home

A

aldrete

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32
Q

what are the components of the aldrete score?

A
  1. activity (ability to move extremities voluntarily/follow commands) 2. respiration (can they breathe deeply and cough freely?) 3. circulation (BP +/- % of preanesthetic level) 4. level of consciousness 5. oxygenation
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33
Q

the “muscle cone” of the eye is formed by __________ extraocular muscles

A

6

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34
Q

what are the 3 layers of (eye) globe wall?

A
  1. sclera (outermost) 2. uveal tract 3. retina
35
Q

what is the fx of the sclera

A

maintains the shape of hte eye

36
Q

what is found within the middle layer of the globe wall, (aka uveal tract)

A
  1. choroid 2. iris 3. ciliary body
37
Q

________________ is the part of the eye that produces aqueous humor

A

ciliary body

38
Q

____________ is within the uveal tract of the eye, where the vessels and capillaries are found

A

choroid

39
Q

dilation of the iris is via _____________ stimulation, and constriction is via _____________

A

SNS; PNS

40
Q

_________________ is part of the eye where photoreceptors are stimulated by light, and signals the optic nerve

A

retina

41
Q

__________________ is the artery that provides most of the blood flow to the eye

A

ophthalamic

42
Q

T/F: veins in the eye are valveless

A

TRUE

43
Q

the optic nerve (CN II), is technically an outgrowth of the brain covered by meninges. This creates an ___________________ space, which injections can accidently go into

A

orbital epidural

44
Q

if an injection into the optic nerve goes into the orbital epidural space, this can go directly to the ____________ via CSF causing ______________ and/or ___________

A

midbrain; CNS depression; respiratory arrest

45
Q

if you suspect an optic nerve injection went into the epidural space, you should check the ________________ pupil

A

contralateral (will be dilated)

46
Q

which nerve is the primary motor nerve for extraocular motion

A

oculomotor (CN III)

47
Q

fx of oculomotor nerve at the eye

A
  1. extraocular motor movement 2. PNS innervation of iris –> constx
48
Q

the oculomotor nerve controls all extraocular muscle movement, except for _________________ & ______________

A

lateral rectus; superior oblique

49
Q

which nerve controls motor function of the lateral rectus muscle

A

abducens (CN VI)

50
Q

which nerve controls the motor function of the superior oblique muscle

A

Trochlear nerve (CN IV)

51
Q

which nerve is the primary sensory nerve of the eye

A

trigeminal (CN V)

52
Q

the trigeminal nerve (CN V) controls sensation to?

A
  1. cornea 2. ciliary body 3. iris 4. lacrimal gland 5. conjunctiva 6. eye lid 7. eyebrow 8. forehead 9. nose 10. nasal mucosa
53
Q

which nerve controls motor eye lid contraction?

A

facial (VII)

54
Q

what effect does hypoventilation, causing hypercarbia have on IOP?

A

increases IOP

55
Q

hypoxia will _____________ IOP

A

increase

56
Q

coughing, straining, vomiting, and/or intubation can increase IOP to ______________, which have serious implication with ______________ injury

A

30-40 mmHg; open globe

57
Q

anesthetic goals for pt with glaucoma

A
  1. avoid venous congestion/fluid overload 2. avoid hypotension
58
Q

what are the different types of procedures that can be done for glaucoma

A
  1. trabulectomy 2. ahmed shunt device 3. laser to trabecular meshwork
59
Q

what is the anesthetic choice for the glaucoma procedures? (trabulectomy, ahmed shunt, laser to trabecular network)

A

MAC

60
Q

ahmed shunt device will function to do what?

A

drain aqueous humor under the conjunctiva

61
Q

what is the purpose of a trabulectomy?

A

excision of trabecula to increase drainage of aqueous humor

62
Q

which ocular medications function to decrease aqueous humor production?

A
  1. beta blockers (timolol) 2. Alpha-2 agonists (brimonidine) 3. carbonic anhydrase inhibitors (acetazolamide)
63
Q

which ocular medications function to increase the outflow of aqueous humor?

A
  1. acetylcholine (Miochol-E) 2. anticholinesterases (physostigmine & echothiophate) 3. prostaglandins (lanoprost and bimatoprost)
64
Q

what are some regional anesthetic techniques used in opthalmologic surgery?

A
  1. peribulbar block (extraconal) 2. retrobulbar block (intraconal) 3. sub-tenon block
65
Q

what is the recommended LA used for regional anesthetic in opthalmologic surgeries?

A

lidocaine 2% and Bupivicaine 0.5%

66
Q

what are complications with regional anesthesia techniques for opthalmologic surgies?

A
  1. intravascular injeciton –> seizures 2. globe puncture 3. optic nerve injury 4. superficial hemorrhage 5. retrobulbar hemorrhage 6. retinal vascular events 7. muscle palsy 8. loss of vision 9. respiratory arrest from CSF infiltration via optic nerve 10. oculocardiac reflex 11. central retinal artery occlusion 12. inadvertent brainstem anesthesia
67
Q

what is the pro of using succinylcholine with open globe injury procedure

A

faster onset than with NDMR

68
Q

what is the con of using succinylcholine with open globe injury procedure

A

increases IOP 5-10 mmhg for 5-10 minutes

69
Q

pros of using NDMR with open globe injury procedure

A
  1. satisfactory for induction 2. decreases IOP 3. now have suggamadex to reverse quickly
70
Q

cons of using NDMR with open globe injury procedure

A
  1. slower onset 2. slower to metabolize/wear off
71
Q

ophthalmic drop medications are absorbed at a rate that is slower than ____________, but faster than __________

A

IV; subQ

72
Q

what are some techniques to increase absorption of ophthalmic medication and decrease lacrimal drainage?

A
  1. close eyes for 60 seconds 2. hold external pressure on medial canthus 3. no blinking
73
Q

considerations with MAC technique for ophthalmic surgery

A
  1. pt must be cooperative 2. must be able to lie flat 3. may not be best choice if pt: snores, OSA, claustrophobic, anxious
74
Q

which regional anesthetic block for ophthalmic surgery has the highest risk of retrobulbar hemorrhage

A

retrobulbar block

75
Q

regional anesthetic techniques for ophthalmic surgery, which is injected intraconal?

A

retrobulbar

76
Q

what are the advantages of a retrobulbar block, compared to peribulbar

A
  1. smaller volume needed (3-5 mL) 2. more rapid onset (~ 2min) 3. lower risk of block failure
77
Q

what are the cons with retrobulbar block compared to peribulbar

A

increased risk of retrobulbar hemorrhage

78
Q

what depth does should the needle not exceed when doing a retrobulbar block in order to avoid the deeop orbital structures

A

1 “

79
Q

what are the cons of a peribulbar block compared to retrobulbar

A
  1. requires larger vol (4-6 mL but up to 8-10 mL) 2. higher risk of block failure 3. longer onset (10 min) 4. 2 injections (upper and lower)
80
Q

what are the pros of a peribulbar block compared to retrobulbar

A

lower risk of retrobulbar hemorrhage

81
Q

______________ globe injury, the IOP is atmospheric

A

open

82
Q

which which type of globe injury is it important to preven the extrusion of contents

A

open

83
Q

which globe injury is it vital to prevent increases in IOP

A

closed globe

84
Q

when pressure is put on the globe of the eye and traction on the extraocular muscle it triggers the oculocardiac reflex, the afferent nerve in this process is _________________, and the efferent is _____________________.

A

trigeminal; vagus

Justin Lyle Cards (27 decks)

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