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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Anaesthesia for paediatric eye surgery
Consultant Anaesthetist
Great Ormond Street Hospital For Children
London WC1N 3JH, UK
Tel: +44 020 7813 8208 E-mail: jamesi@gosh.nhs.uk
Key Words: Bradycardia is readily produced by traction on extraocular muscles or pressure on the globe (oculocardiac reflex). • Squint surgery is associated with a high incidence of postoperative vomiting. • Procedures on the nasolacrimal ducts in children with a cardiac lesion require antibiotic prophylaxis. • Avoid nitrous oxide in vitreoretinal surgery. • Succinylcholine is not contraindicated in non-fasted patients with a penetrating eye injury.
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Although surgical procedures on the eye in adults are frequently performed using local anaesthesia, children undergoing eye surgery will nearly always require general anaesthesia. These procedures (Table 1) encompass the entire paediatric age range, including newborn infants.
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Preoperative assessment |
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Most children scheduled for eye surgery are ASA Class I or II and can be managed as day cases. Anaesthesia is usually straightforward; however, in some children, the eye problem may be part of a chromosomal or metabolic disorder with anaesthetic implications. In many cases, the associated anomaly is limited to developmental delay, mental retardation and behavioural problems and the challenge lies in managing these patients in a sympathetic manner. In others, the association may be of more direct anaesthetic relevance.
A number of syndromes in which there can be major difficulties with intubation are associated with cataracts, glaucoma or squints. These include
Bacterial endocarditis prophylaxis
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General principles of anaesthesia |
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Specific procedures |
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Examination of the eyes
Measurement of intraocular pressure
Syringing and probing of nasolacrimal ducts
Strabismus surgery
Oculocardiac reflex
Postoperative vomiting
Postoperative analgesia
Enucleation and evisceration
Intraocular surgery
Vitreoretinal surgery
Emergency surgery
Retinopathy of prematurity