Adequate preoperative evaluation and optimization are important in the prevention of same day cancellation and unplanned hospital admission. However, ophthalmic surgery is often carried out in elderly patients who have a high prevalence of coexisting illnesses such as diabetes, hypertension, coronary artery disease, and chronic obstructive pulmonary disease. Ophthalmic procedures are generally considered low risk because they do not cause significant physiological perturbations, and do not involve a large volume of blood loss or significant postoperative pain. Patients who undergo ophthalmic surgery can be as young as preterm infants to nonagenarians. The majority of ophthalmic surgeries are short in duration and primarily performed in ambulatory surgical centers. They consist of a broad spectrum of procedures, ranging from cataract surgery with minimal sedation to more complex procedures such as orbital decompression, or combined corneal transplantation and retinal surgery that requires general anesthesia. Ophthalmic surgeries are the most common operations performed in the elderly. Anesthesia providers specialized in ophthalmic anesthesia play an important role in helping patients undergo surgery comfortably and safely. Early diagnosis and treatment, including surgery, can potentially reverse vision impairment, such as in cataract extraction, or delay and attenuate the pathophysiological process, as in glaucoma and diabetic retinopathy. Currently, about 4.2 million adults in the United States are visually impaired. Visual impairment and blindness limit a person’s ability to function normally in daily living, has a large economic impact in the United States, and results in significant loss of quality-adjusted life years. Vision is one of the most important functions of the human body. Prevention of prolonged postoperative anesthesia care unit stay and unanticipated hospital admission requires careful patient evaluation, optimization of underlying medical conditions, adequate pain control, prevention of postoperative nausea and vomiting, and maintenance of hemodynamic stability. Succinylcholine can be used in unfasted patients who have an open-globe injury that requires emergent vision-saving surgery under general anesthesia. Strabismus surgery is an independent risk factor for postoperative vomiting in pediatric patients.
#Anesthesia for retina detachment surgery elderly mac
This includes pediatric ophthalmic surgery complex procedures, some of which require muscle relaxation and adults who cannot undergo MAC for a variety of reasons. General anesthesia is required in 30% to 40% of ophthalmic surgeries. Routine preoperative laboratory testing is not necessary for cataract surgery and has not been shown to reduce adverse perioperative events. Orbital blocks, particularly retrobulbar blocks, can have severe complications, including retrobulbar hemorrhage, and retrograde spread of local anesthetic into the subarachnoid space causing brainstem anesthesia, loss of consciousness, and respiratory arrest. This includes the effect of anesthetic drugs and interventions on intraocular pressure and systemic effects of ophthalmologic medications. The majority of ophthalmic procedures can be performed under topical anesthesia or orbital block in combination with monitored anesthesia care (MAC).Ī working knowledge of the anatomy and physiology of the eye is essential in providing safe anesthesia care. The demand for efficiency while maintaining patient safety is a challenge.
Some ophthalmic surgeries (cataract, glaucoma, simple vitrectomy) are short procedures, but high in volume. Ophthalmic procedures are considered to be “low-risk.” However, the patient population is higher risk because of the extremes of age involved and associated comorbidities.
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