Trauma - Ocular and Maxillofacial

Question 1

ocular trauma: anesthesia goals

Answer 1

• smooth induction and emergence
• akinesia
• analgesia
• attenuate IOP rise
• ablate OCR
• minimize bleeding

Question 2

normal intra-ocular pressure

Answer 2

10-20 mmHg

Question 3

ways to decrease/maintain intraocular pressure

Answer 3

• not increase blood volume
• maintain aqueous humor outflow
• no external pressure on eye (avoid retrobulbar block)
• no Valsalva maneuvers (no positive pressure ventilation)

Question 4

oculocardiac reflex: causes

Answer 4

• direct trauma
• globe pressure
• manipulation of EOM
• block placement

Question 5

oculocardiac reflex: pathway

Answer 5

• afferent: trigeminal - CN 5

- efferent: vagus - CN 10 (effects=bradycardia, arrhythmias, asystole)

Question 6

oculocardiac reflex: aggravating factors

Answer 6

• hypoxemia
• hypercarbia
• light anesthesia

Question 7

when is a retrobulbar block contraindicated?

Answer 7

• closed globe with increase IOP

- open globe

Question 8

Le Fort Classification

Answer 8

I: separation of upper jaw
II: triangular fracture, may communicate with cranial vault
III: complete fracture through eyes, communicates with cranial vault, unable to bag mask

*as the grade increases so does the swelling and bleeding

Question 9

basilar skull fractures - fossa signs

Answer 9

• anterior: raccoon eyes
• middle: blood/CSF from ears
• posterior: bruising behind ears

Question 10

open eye injuries

Answer 10

full-thickness around the eye wall (cornea and clear)

if open eye, fluroquinolones are the only agent that penetrate the vitreous (levofloxacin)

Question 11

closed eye injuries

Answer 11

mean the cornea and/or sclera are preserved

Question 12

what is a normal eye psi and at what psi can you have vision loss

Answer 12

normal IOP 10-20 mmHG

psis >25 can lead to vision loss. Anything that increases ICP increases IOP.