Anaesthesia for eye surgery in paediatrics

Publication date: Available online 26 November 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Tom Y. Pettigrew, Sarah J. SmithAbstractChildren are rarely able to tolerate being awake for any type of surgery under local anaesthesia, therefore the majority of paediatric eye surgery is performed under general anaesthesia. Most patients presenting on a paediatric ophthalmology operating list will be otherwise healthy children who are suitable for day surgery. However, some children may have eye abnormalities as part of a congenital disorder. The perioperative plan should be formulated after assessment of the child's behaviour, co-existing medical issues and the surgical conditions required for the specific procedure. Factors influencing Intraocular pressure may require to be controlled, and anaesthetists should be vigilant for the oculocardiac reflex. Postoperative nausea and vomiting (PONV) is increased in ocular surgery, particularly with strabismus correction. Pain and opioid analgesics can both increase the risk of PONV. In most cases, simple analgesia and the intraoperative use of topical local anaesthesia will provide effective postoperative pain relief.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research

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Publication date: Available online 25 November 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): Stuart Young, Aravind BasavarajuAbstractThe majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye s...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Conclusion The m.10191T>C mutation in the mtDNA of the complex I (CI) subunit of MTND3 results in the substitution of a highly conserved amino acid (p.Ser45Pro) within the ND3 protein, leading to CI dysfunction through impaired enzyme catalysis rather than impaired stability or assembly, causing a broad clinical spectrum of disorders (26). Patients with the m.10191T>C mutation are rare. In the present study, we report on a family of patients with the extremely rare adult-onset Leigh-like syndrome with the m.10191T>C mutation. Including the two patients from our reported family, the m.10191T>C mutation has bee...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
CONCLUSION: Morbidity associated with ophthalmic pediatric surgery is low and predominantly associated with strabismus surgery. The benefit-risk ratio and cost-effectiveness of oculocardiac reflex prevention should be questioned. Our postoperative nausea and vomiting rate is low, thanks to the use of a well-managed multimodal strategy. Early postoperative pain is usually well-treated but could probably be more effectively prevented. PMID: 30280604 [PubMed - as supplied by publisher]
Source: European Journal of Ophthalmology - Category: Opthalmology Authors: Tags: Eur J Ophthalmol Source Type: research
Conditions:   Strabismus;   Bradycardia;   Nausea;   Pain Intervention:   Drug: Topical Solution Sponsor:   Alaska Blind Child Discovery Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Authors: Talebnejad MR, Khademi S, Ghani M, Khalili MR, Nowroozzadeh MH Abstract PURPOSE: Oculocardiac reflex (OCR), defined as bradycardia induced by manipulation of extraocular muscles, is a serious complication during strabismus surgery for which prevention and proper management is required. In the present study, we investigated the efficacy of sub-Tenon injection of bupivacaine for prevention of OCR and postoperative pain. METHODS: A prospective randomized controlled clinical trial was conducted. Fifty patients who were candidates for strabismus surgery were randomized into case (sub-Tenon's bupivacaine inj...
Source: Journal of Ophthalmic and Vision Research - Category: Opthalmology Tags: J Ophthalmic Vis Res Source Type: research
Discussion Inflammation of the middle layer of the eye, or uvea, is termed uveitis. Uveitis can be divided into anterior, intermediate or posterior uveitis by involving the anterior (iris and ciliary body), intermediate (vitreous) or posterior (choroid and usually retina) compartments. Panuveitis involves all 3 compartments. Duration can also be used to classify uveitis. Acute is 6 weeks and> 3 months is chronic persistent uveitis. Episodic periods of inactivity and reactivity that last more than 3 months are called recurrent uveitis. A third way to characterize uveitis is if it is granulomatous or not. Uveitis increase...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Publication date: Available online 27 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Ian D.M. Davies, Steven M. Sale Local anaesthesia is often the technique of choice for ophthalmic procedures performed on adults; however, general anaesthesia is usually required for procedures on children. The majority of paediatric patients are fit and healthy but there is a minority in whom the presenting eye complaint is related to a congenital disorder, which may have significant bearing on the conduct of anaesthesia. Management of the airway and presentation of a quiescent eye for surgery are key considera...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 25 November 2016 Source:Anaesthesia & Intensive Care Medicine Author(s): Nicholas C.B. Pritchard Local anaesthesia for eye surgery is increasingly popular, but there will always be a need for general anaesthesia. Patients may refuse local anaesthesia, may be unable to keep still or lie flat for the duration of surgery or lack the mental facility to cooperate whilst awake. Young children and those with allergy to local anaesthetic also need general anaesthesia. Careful patient preparation is important before surgery. Glycaemic control in patients with diabetes, adjustments to warfarin...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Conclusion Administration of intranasal dexmedetomidine to children undergoing strabismus surgery under sevoflurane anesthesia resulted in a reduced incidence of EA compared with intranasal midazolam or placebo. The incidence of POV and intraoperative OCR was also significantly lower with dexmedetomidine.
Source: Egyptian Journal of Anaesthesia - Category: Anesthesiology Source Type: research
Conclusions In conclusion, we think that a sub-Tenon's block, combined with general anesthesia, is not effective and reliable in decreasing oculocardiac reflex and postoperative nausea and vomiting. However, this method is safe for reducing postoperative pain and decreasing additional analgesia required in pediatric strabismus surgery.
Source: Brazilian Journal of Anesthesiology - Category: Anesthesiology Source Type: research
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