Regional Anesthesia With Monitored Anesthesia Care for Surgical Repair of Selected Open Globe Injuries

Gayer, Steven; Voo, Irene; Flynn, Harry W.; Diniz, José Ricardo; Venkatraman, Anna S.

doi:10.3928/1542-8877-20050301-08

Cited by 19 publications

(5 citation statements)

References 9 publications

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“…Subsequently, Scott et al performed a retrospective study of 238 open globe injuries treated between 2000 and 2003 and found that patients managed with sedation and locoregional anesthesia were more likely to have anterior wounds ( P <0.001) and less likely to have an afferent pupillary defect (12% vs 43%). 14 In this study, the use of local anesthesia was not associated with the increased risk of extrusion of globe contents and did not result in impairment in long-term visual outcome. Many centers continue to manage ocular trauma under GA because providers are uncomfortable administering blocks to the traumatized eye.…”

Section: Ocular Traumamentioning

confidence: 46%

Ophthalmic regional blocks: management, challenges, and solutions

Palte¹

2015

LRA

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In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon’s block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma.

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Section: Ocular Traumamentioning

confidence: 46%

Ophthalmic regional blocks: management, challenges, and solutions

Palte¹

2015

LRA

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“…In a later study, Scott et al reviewed a further 238 OGI and compared visual outcomes in relation to regional versus general anesthesia. 16 This study found no difference in terms of improvements in post versus pre-operative visual acuity between the two groups. Moreover, McClellan et al performed a retrospective review of 448 OGI at their institution over an eleven-year period.…”

Section: Open Globe Injurymentioning

confidence: 52%

Contemporary Anesthesia Perspectives for Ophthalmic Surgery: A Brief Review

Palte,

Masters

2023

MRAJ

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In recent decades there have been few changes in the anesthesia management of eye surgery. By contrast, the 21st Century has witnessed major advancements in ophthalmic surgery with the adoption of minimally-invasive techniques, technologic innovations, and an expanding population seeking eye care. These factors have impacted intraoperative exposure such that many procedures are now performed on more complex patients, and completed in quicker time. Furthermore, in pursuit of economic savings and patient satisfaction there is a trend to divert eye surgeries away from the in-hospital setting to ambulatory centers or office locations. From an anesthesia perspective, these changes have imposed a demand on providers to shorten operating room turnover times and accelerate patient discharge while maintaining high standards of patient safety. This review will address five new avenues of anesthesia care, each of which offer possibilities in accommodating facets of this new order surgical experience. First, remimazolam is an ultra-short acting benzodiazepine that produces a predictable period of hypnosis and rapid, full recovery of consciousness because of its short context-sensitive half-time and inactive metabolites. A single 3-5 mg dose produces 11-15 minutes sleep that may be ideal for brief ocular interventions. Second, nasal CPAP/BiPAP and high flow nasal oxygen devices expand the profile of patients appropriately managed at an ambulatory center. Since their application improves arterial oxygenation and delays the onset of apneic hypoxemia, they are advantageous for patients afflicted by morbid obesity or severe obstructive sleep apnea. Third, open globe injuries have traditionally been managed under general anesthesia. However, recent studies attest to regional anesthesia as a viable alternative for many ocular insults, particularly for the elderly and patients with major organ dysfunction or risk for pulmonary aspiration. Fourth, the sub-Tenon block is a cannula-based regional ophthalmic skill performed predeominantly by ophthalmic surgeons because it necessitates conjunctival incision and dissection. Recently described variations of an incision-free, easily mastered sub-Tenon approach are likely to be included in residency and fellowship instruction, and so become an invaluable component of the anesthesiology armamentarium. This review concludes with a concise overview of the a2 agonist dexmedetomidine with the focus directed on its uses as an adjunct for adult sedation, and advantage in children for premedication and control of emergence delirium.

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“…6,7 Based on data in the current study, ophthalmologists and anesthesiologists may consider this type of anesthesia as a reasonable alternative to general anesthesia for the repair of open globe injuries in selected patients.…”

Section: Discussionmentioning

confidence: 93%

Comparison of Regional vs. General Anesthesia for Surgical Repair of Open-Globe Injuries at a University Referral Center

McClellan

Daubert

Relhan

et al. 2017

Ophthalmology Retina

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Purpose This study compares the clinical features and physician selection of either Regional Anesthesia (peribulbar or retrobulbar block) with Monitored Anesthesia Care (RA-MAC) or General Anesthesia (GA) for open globe injury repair. Design A non-randomized, comparative, retrospective case series at a University Referral Center. Participants All adult repairable open globe injuries receiving primary repair between January 1st, 2004 and December 31st, 2014 (11 years). Exclusion criteria were patients less than 18 years of age and those treated with primary enucleation. Methods Data was gathered via retrospective chart review. Main Outcome Measures Data collected from each patient was age, gender, injury type, location, length of wound, presenting visual acuity, classification of anesthesia used, duration of the procedure performed, months of clinical follow-up, and final visual acuity. Results During the 11 years study period, 448 patients were identified who had open globe injuries with documented information on zone of injury. Globe injury repair was performed using RA-MAC in 351/448 (78%) patients and general anesthesia in 97/448 (22%) patients. Zone 1, 2 and 3 injuries were recorded in 241, 135, and 72 patients respectively. The rates in specific zones, of RA-MAC versus GA were as follows: Zone 1 – 213/241 (88%) vs 28/241 (12%), Zone 2 – 104/135 (77%) vs 31/135 (23%) and Zone 3 – 34/72 (47%) vs 38/72 (53%). Open globe injuries repaired under RA-MAC had significantly shorter wound length (p<0.001), more anterior wound location (p<0.001) and shorter operative times (p<0.001). RA-MAC cases also had a better presenting and final visual acuity (p<0.001). Neither class of anesthesia conferred a greater visual acuity improvement (p=0.06). The use of GA did not cause any delay in the time elapsed from injury until surgical repair (p=0.74). Conclusions RA-MAC is a reasonable alternative to GA for the repair of open globe injuries in selected adult patients. RA-MAC was selected more often for Zone 1 and Zone 2 injuries. For eyes with Zone 3 injuries, there are equal selection ratio for RA-MAC and GA.

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Regional Anesthesia With Monitored Anesthesia Care for Surgical Repair of Selected Open Globe Injuries

Cited by 19 publications

References 9 publications

Ophthalmic regional blocks: management, challenges, and solutions

Ophthalmic regional blocks: management, challenges, and solutions

Contemporary Anesthesia Perspectives for Ophthalmic Surgery: A Brief Review

Comparison of Regional vs. General Anesthesia for Surgical Repair of Open-Globe Injuries at a University Referral Center

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