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Levi's Class 2014 > Week 1 Anesthesia for Eye Surgery > Flashcards

Week 1 Anesthesia for Eye Surgery Flashcards

1
Q

The eye resides in the _________ bony structure.

A

pyramidal

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2
Q

What are the three layers of the eye?

A
  • Sclera
  • Uveal tract (middle layer)
  • Retina
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3
Q

Where does the eye get most of its focusing power?

A

Curvature of the cornea

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4
Q

Name the three layers of the uveal tract (middle layer)?

A
  • Choroid
  • Ciliary body
  • Iris
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5
Q

What are the features of the choroid layer in the eye? (Uveal layer)

A
  • Layer of blood vessels

- Located posterior

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6
Q

What are the features of the ciliary body of the eye? (Uveal Layer)

A
  • Resides behind the iris
  • produces the aqueous humor
  • adjust the focus on the lens by reducing the tension on suspension fibers or zonules of the lens
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7
Q

What are the feature of the Iris? (Uveal layer)

A
  • Pigmented

- Controls the light entry

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8
Q

What occurs within the iris during sympathetic response in the eye?

A

-Iris DILATOR muscle contracts

dilitation or MYDRIASIS

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9
Q

What occurs within the iris during a parasympathetic response in the eye?

A

-iris SPINCTER muscles contracts

pupillary constriction or MYIOSIS

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10
Q

The retina ends __ mm behind the iris.

A

4

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11
Q

Where is the Pars plana located?

A

-Area between limbus (edge) of cornea and end of retina

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12
Q

T/F: The Pars plana is the safe entry point for vitectomy procedures?

A

TRUE

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13
Q

How does ocular cardiac reflex (OCR) manifest?

A
  • bradycardia
  • AV block
  • ventricular ectopy
  • asystole (rarely)
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14
Q

Ocular cardiac reflex is seen especially with traction on this muscle?

A

Medial rectus

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15
Q

What nerve is primarily responsible for the ocular cardiac reflex?

A

-Trigeminovagal

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16
Q

T/F: The ocular cardiac reflex will improve with hypoxemia and hypercarbia.

A

FALSE

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17
Q

How would ocular cardiac reflex be treated?

A
  • Ask surgeon to stop
  • Assess ventilation
  • Lidocaine localization or deepen anesthetic
  • Atropine
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18
Q

T/F: Ocular cardiac response fatigues with repeated stimulation.

A

TRUE

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19
Q

What regulate the intraocular pressure (IOP)?

A
  • aqueous fluid

- blood volume

20
Q

What is normal intraocular pressure (IOP)?

A

10 to 22 mmHg

21
Q

If intraocular pressure rises above __ mmHg it is considered _______.

A

> 22

-pathological

22
Q

Aqueous fluid production is constant and facilitated by _________.

A

carbonic anhydrase

23
Q

Increase intraocular pressure leads to ocular HTN and structural changes causing?

A
  • atrophy of optic disc
  • atrophy of nerve fibers
  • optic artery occlusion
24
Q

Decreased intraocular pressure leads to:

A

-fluid accumulation in the eye

25
Q

An increase to CVP increases intraocular pressure more than the increase of ___________.

A

blood pressure

26
Q

How much could coughing increase intraocular pressure?

A

40 mmHg

27
Q

What will occur to intraocular pressure if PaCO2 drops suddenly?

A

-FAST drop in IOP due to choroidial vasoconstriction

28
Q

What will occur to intraocular pressure if PaCO2 increases?

A

-SLOW increase in IOP

29
Q

Metabolic acidosis _______ the choroid vessel volume and therefore IOP.

A

Decreases

30
Q

Metabolic alkalosis ________ the choroid volume and the IOP.

A

increases

31
Q

What will most anesthetic drugs do to the IOP.

A

Decrease the IOP

32
Q

What two anesthetic drugs would be avoided if elevated IOP was a concern

A
  • Etomidate

- Ketamine

33
Q

Non depolarizing NMR do not alter IOP with exception of curare which ______ it.

A

decrease

34
Q

Azetazolamide (Diamox) is used to ________ aqueous production by carbonic anhydrase inhibitor.

A

Decrease

35
Q

Osmotic diuretic will ______ IOP and will have a max effect at 30 to 45 minutes and return to normal after ____.

A
  • decrease

- 5-6 hours

36
Q

Echothipate opth. is used to treat glaucoma and is a ___________ drug. This could prolong muscle paralysis after __________.

A
  • anticholinesterase

- succinylcholine

37
Q

Flomax ( Tamsulosin) is selective alpha antagonistic. It binds to the dilator muscle causing dilation and complicates cataract surgery. This could last for up to ______ off therapy.

A

7 - 28 days

38
Q

Facial nerve block causes what block to the eye muscle?

A

orbicular oculi muscle

39
Q

What are the three facial nerve blocks?

A
  • Van Lint.
  • Atkinson
  • O’Brian
40
Q

What is the major complication of a facial nerve block?

A

subcutaneous hemorrhage

41
Q

What will the Nadbath Rehman block and effect.

A

BLOCK
-Entire tunk of facial nerve

EFFECT

  • lower facial droop postop for several hour
  • vocal cord paralysis,laryngospasm, dysphasia and respiratory distress (close to the vagus and glossopharyngeal nerve)
42
Q

What muscle may not be blocked by a retrobulbar block?

A

-Superior rectus muscle

43
Q

Retrobulbar hemorrhage is the most common complication of the block and observation of _____ must be monitored.

A

ocular cardiac reflex (OCR)

44
Q

Injection of the block in the optic sheath could cause what complications?

A
  • contralateral amaurosis (lack of vision)
  • obtundation
  • respiratory arrest (within 20 minute and last for up to an hour)
  • vascular collapse form depressant effect on the medulla (total spinal)
45
Q

If sulfur hexaflouride is used as an air bubble in eye surgery then N2O should be d/c’d __ minutes before placement of bubble and avoided ______ days after surgery.

A
  • 15

- 7 to 15

46
Q

If Perfluoropropane is used as the air bubble in eye surgery then avoid N2O for up to ___ month after instillation.

A

1

47
Q

Ketamine in eye surgery is usually avoided due to __________.

A

nystagmus

Levi's Class 2014 (16 decks)

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