Anesthesia for Ophthalmic Surgery Flashcards
(163 cards)
1
Q
Ocular anatomy–the eye has ___ layers…what are they?
A
The eye has 3 layers; they are sclera, uveal tract, retina
2
Q
What is the middle layer of the eye?
A
Uveal tract
3
Q
What is the outermost layer of the eye?
A
Sclera
4
Q
The sclera is the ___ layer of the eye; it is ___, ____, ___ of the eye
A
The sclera is the outermost layer of the eye; it is tough, fibrous, white of the eye
5
Q
What is the most anterior part of the eye?
A
Cornea
6
Q
Most focus power is from the ___ of the cornea
A
Most focus power is from the curvature of the cornea
7
Q
What is the middle layer of the eye and what are the (3) structures of this layer?
A
Middle layer = uveal tract
- Choroid
- Ciliary body
- Iris
8
Q
The choroid is a layer of ___, located ___ (anteriorly/posteriorly)
A
The choroid is a layer of blood vessels, located posteriorly
9
Q
The ciliary body is located behind the ___, produces ___; it adjusts focus on lens by reducing tension on ___ fibers or ___ of the lens
A
The ciliary body is located behind the iris, produces aqueous humor; it adjusts focus on lens by reducing tension on suspension fibers or zonules of the lens
10
Q
The iris is ___ and controls ___ entry
A
The iris is pigmented and controls light entry
11
Q
Sympathetic stimulation = iris dilator muscle contracts, it causes pupil ___ (dilation/constriction) or ___sis
A
Sympathetic stimulation = iris dilator muscle contracts, it causes pupil dilation or mydriasis
12
Q
Parasympathetic stimulation = iris sphincter muscles contract, causing pupillary ___ (dilation/constriction) or ___sis
A
Parasympathetic stimulation = iris sphincter muscles contract, causing pupillary constriction or miosis
13
Q
Sympathetic stimulation = iris ___ (dilator/sphincter) muscle contracts, causing pupil ___ (dilation/constriction) or ___sis
A
Sympathetic stimulation = iris dilator muscle contracts, causing pupil dilation or mydriasis
14
Q
Parasympathetic stimulation = iris ___ (dilator/sphincter) muscles contract, causing pupillary ___ (dilation/constriction) or ___sis
A
Parasympathetic stimulation = iris sphincter muscles contract, causing pupillary constriction or miosis
15
Q
The retina is the ___most layer of the eye
A
The retina is the innermost layer of the eye
16
Q
What receptors in the retina produce a neural signal when activated by light?
A
Photoreceptors
17
Q
The retina ___ (does/does not) contain capillaries
A
The retina does NOT contain capillaries
18
Q
Since the retina does not contain capillaries, what layer of the eye provides oxygen to the retina?
A
Choroid layer provides oxygen to the retina
19
Q
Retinal detachment from the choroid compromises blood supply and is a major cause of vision loss–T/F?
A
True
20
Q
The retina ends ___ mm behind the iris
A
The retina ends 4 mm behind the iris
21
Q
What is the area between the limbus (edge) of the cornea and end of the retina?
A
Pars plana
22
Q
The pars plana is a safe entry area for what procedures?
A
The pars plana is a safe entry area for vitrectomy procedures
23
Q
The center of the eye is filled with ___ gel; it attaches to blood vessels and the ___ nerve; traction of vitreous on the retina causes ___
A
The center of the eye is filled with vitreous gel; it attaches to blood vessels and the optic nerve; traction of vitreous on the retina causes detachment
24
Q
What are (3) indications for a vitrectomy?
A
- Scarring
- Bleeding
- Opacification of vitreous
25
What is the term used to describe a variety of arrhythmias resulting from manipulation of the eye?
Ocular cardiac reflex (OCR)
26
Ocular cardiac reflex (OCR) manifests as ___cardia, ___ block, ventricular ___ and ___ (rarely)
Ocular cardiac reflex (OCR) manifests as bradycardia, AV block, ventricular ectopy and asystole (rarely)
27
OCR can occur with any stimulation of orbital contents, including lid and periosteum--T/F?
True
28
OCR is seen especially with traction of what particular muscle of the eye?
Medial rectus traction
29
OCR is ___ (from what cranial nerves does it originate?)*** Memorize
OCR is trigeminovagal
***Memorize
30
___ (afferent/efferent) impulses of the OCR originate in orbital contents (via long and short ciliary nerves)***Memorize
AFFERENT impulses of the OCR originate in orbital contents (via long and short ciliary nerves)
***Memorize
31
Afferent impulses from the OCR travel to the ___ ganglion, to the ___ division of the ___ nerve, to the ___ (sensory/motor) nucleus of the ___ nerve near the ___ ventricle, to visceral motor nuclei of the ___ nerve***Memorize
Afferent impulses from the OCR travel to the ciliary ganglion, to the ophthalmic division of the trigeminal nerve, to the sensory nucleus of the trigeminal nerve near the fourth ventricle, to visceral motor nuclei of the vagus nerve
***Memorize
32
Efferent limb of the OCR is ___ nerve to the ___***Memorize
Efferent limb of the OCR is vagus nerve to the heart
***Memorize
33
The OCR occurs more frequently in adults than peds--T/F?***Memorize
FALSE--OCR occurs more frequently in peds than adults
***Memorize
34
OCR may be seen during topical and general anesthesia--T/F?
True
35
OCR is seen ___ (more/less) during retrobulbar blocks
OCR is seen LESS during retrobulbar blocks
~Although orbital injections can stimulate reflex
36
OCR response is worsened by ___emia and ___carbia
OCR response is worsened by hypoxemia and hypercarbia
37
What should you do FIRST if OCR occurs?
Ask the surgeon to stop manipulation of the eye
38
Other steps in treatment of OCR--assess adequacy of ___; ___ localization or ___ anesthetic may help; for persistent bradycardia, treat with ___
Other steps in treatment of OCR--assess adequacy of ventilation; lidocaine localization or deepening anesthetic may help; for persistent bradycardia, treat with atropine
39
The OCR response becomes stronger with repeated stimulations--T/F?
FALSE--OCR response fatigues with repeated stimulations
40
Pretreatment with what (2) medications can be effective in preventing OCR? What patient populations should you consider this for?
Pretreatment with glyco or atropine can be effective in preventing OCR; consider this in patients with conduction block or on beta blocker
41
Blood supply to the eye is dependent on ___ perfusion pressure
Blood supply to the eye is dependent on intraocular perfusion pressure
MAP - IOP
42
___ (low/high) IOP impairs blood supply and optic nerve function
High IOP impairs blood supply and optic nerve function
43
Once the globe is open, factors increasing IOP can cause prolapse and loss of IO contents, resulting in permanent vision loss--T/F?
True
44
The globe is relatively ___ (compliant/non-compliant)
The globe is relatively NON-compliant
45
Volume in the globe is relatively fixed, except for ___ fluid and ___ blood volume
Volume in the globe is relatively fixed, except for aqueous fluid and choroid blood volume
46
What (2) quantities regulate IOP?
- Aqueous fluid volume
| - Choroid blood volume
47
Normal IOP = ___-___ mm Hg
Normal IOP = 10-22 mm Hg
48
IOP > ___ mm Hg is pathological
IOP > 25 mm Hg is pathological
49
Production of aqueous humor is facilitated by what enzyme?
Production of aqueous humor is facilitated by carbonic anhydrase
50
Increases in IOP leads to ocular ___tension, ___ changes (i.e.: atrophy of optic disc and nerve fibers, optic artery occlusion)
Increases in IOP leads to ocular hypertension, structural changes (i.e.: atrophy of optic disc and nerve fibers, optic artery occlusion)
51
Decreased IOP leads to fluid ___ (accumulation/removal) in the eye
Decreased IOP leads to fluid accumulation in the eye
52
Arterial pressure effect on IOP--sudden increases in BP ___ (increase/decrease) IOP; this effect is ___ (transient/long lasting) d/t drainage system
Sudden increases in BP increase IOP; this effect is transient d/t drainage system
53
Arterial pressure effect on IOP--sudden decreases in BP < ___ will drop IOP d/t loss of ___; systolic BP of ___ causes 3-4 torr decrease in IOP from decreased blood flow
Sudden decreases in BP < 90 will drop IOP d/t loss of autoregulation; systolic BP of 60 causes 3-4 torr decrease in IOP from decreased blood flow
54
Anesthetic events that increase BP = ___scopy, ___ation, ___ position
Anesthetic events that increase BP = laryngoscopy, intubation, Trendelenburg position
55
Increase in CVP ___ (increases/decreases) IOP, ___ (more/less) than increase in BP
Increase in CVP increases IOP, even more than increase in BP
56
What (4) activities may increase IOP d/t obstruction of drainage?
- Coughing
- Straining
- Breathholding
- Vomiting
57
IOP may increase up to ___x with coughing
IOP may increase up to 40x with coughing
58
Elevation of head ___ (increases/decreases) IOP; lowering head ___ (increases/decreases) IOP d/t mechanical drop
Elevation of head decreases IOP; lowering head increases IOP d/t mechanical drop
59
Direct pressure on the eye from compression in the ___ position (coupled with lower ___) has been indicated in postop vision loss
Direct pressure on the eye from compression in the prone position (coupled with lower systolic BP) has been indicated in postop vision loss
60
Decreased PaCO2 results in a fast ___ (rise/drop) in IOP from choroidal vaso___
Decreased PaCO2 results in a fast drop in IOP from choroidal vasoconstriction
61
Increased PaCO2 results in a slow ___ (increase/decrease) in IOP
Increased PaCO2 results in a slow increase in IOP
62
A fast respiratory rate may ___ (increase/decrease) IOP from insufficient ___ drainage
A fast respiratory rate may increase IOP from insufficient venous drainage
63
Metabolic acidosis ___ (increases/decreases) the choroid vessel volume and therefore ___ (increases/decreases) IOP
Metabolic acidosis decreases the choroid vessel volume and therefore decreases IOP
64
Metabolic alkalosis ___ (increases/decreases) the choroid vessel volume and therefore ___ (increases/decreases) IOP
Metabolic alkalosis increases the choroid vessel volume and therefore increases the IOP
65
Pressure to the globe from external forces may ___ (increase/decrease) IOP
Pressure to the globe from external forces may increase IOP
66
Most anesthetic drugs ___ (increase/decrease) or have ___ on IOP
Most anesthetic drugs decrease or have no effect on IOP
67
Inhalation agents ___ (increase/decrease) IOP by ___ (increasing/decreasing) BP and thereby ___ (increasing/decreasing) choroidal volume; they ___ (relax/contract) extraocular muscles and ___ (increase/decrease) wall tension; pupil ___ (constriction/dilation) enables aqueous outflow
Inhalation agents decrease IOP by decreasing BP and thereby decreasing choroidal volume; they relax extraocular muscles and decrease wall tension; pupil constriction enables aqueous outflow
68
IV agents propofol and thiopental ___ (increase/decrease) IOP
IV agents propofol and thiopental decrease IOP
69
Ketamine may ___ (increase/decrease) IOP because it usually ___ (increases/decreases) BP and doesn't ___ (relax/contract) extraocular muscles
Ketamine may increase IOP because it usually increases BP and doesn't relax extraocular muscles
70
What IV anesthetic is associated with myoclonus and thus may not be appropriate with an open globe?
Etomidate
71
Opioids generally ___ (increase/decrease) IOP
Opioids generally decrease IOP
72
Tracheal intubation will increase IOP if depth of anesthesia is inadequate, regardless of NMB used--T/F?
True
73
Nondepolarizing NMB ___ (do/do not) alter IOP
Nondepolarizing NMB do NOT alter IOP
74
Succinylcholine ___ (does/does not) increase IOP
Succinylcholine DOES increase IOP
75
Succinylcholine increase in IOP starts within ___ minute; IOP increases ___-___ mm Hg for ___-___ minutes d/t prolonged contracture of extraocular muscle
Succinylcholine increase in IOP starts within 1 minute; IOP increase 5-10 mm Hg for 5-10 minutes d/t prolonged contracture of extraocular muscle
76
Glaucoma patients have similar IOP response to succs as people without glaucoma--T/F?
True--the increase in IOP from succs administration is not exaggerated or prolonged in patients with glaucoma
77
Succs can cause false measurements of IOP during exam under anesthesia for glaucoma patients--T/F?
True--measurements may be falsely elevated
78
Rise in IOP from succs administration can cause extrusion of eye contents through an open surgical or traumatic wound--T/F?
True
79
Prolonged contracture from succs administration alters forced duction test (test for extraocular muscle balance) for ___ minutes and may influence the type of strabismus surgery done
Prolonged contracture from succs administration alters forced duction test (test for extraocular muscle balance) for 20 minutes and may influence the type of strabismus surgery done
80
What are (2) diuretics that can be used to decrease IOP?
- Acetazolamide
| - Mannitol
81
Acetazolamide (Diamox) decreases ___ production by inhibiting ___ (what electrolyte?) pump, which decreases IOP; chronic use depletes what (3) electrolytes?
Acetazolamide (Diamox) decreases aqueous production by inhibiting sodium pump, which decreases IOP; chronic use depletes Na, K+, and bicarb
82
What acid-base imbalance can result from chronic diamox use?
Metabolic acidosis
83
Mannitol drops IOP by increasing ___ blood volume; max effect ___-___ minutes, returns to baseline in ___-___ hours
Mannitol drops IOP by increasing circulating blood volume; max effect 30-45 minutes, returns to baseline in 5-6 hours
84
Topically applied eye drugs are absorbed at a rate ___ (slower/faster/intermediate) between subcutaneous and an IV injection
Topically applied eye drugs are absorbed at a rate INTERMEDIATE between subcutaneous and an IV injection
85
Echothiophate is a topical anti___ drug that maintains ___ (mydriasis/miosis) to treat ___
Echothiophate is a topical anti cholinesterase drug that maintains miosis to treat glaucoma
86
Systemic absorption of echothiophate leads to total inhibition of ___, resulting in prolonged ___ after succinylcholine administration
Systemic absorption of echothiophate leads to total inhibition of plasma cholinesterase, resulting in prolonged muscle paralysis after succinylcholine administration
87
Echothiophate may predispose patients to ___-type (amide/ester) local toxicity
Echothiophate may predispose patients to ester-type local toxicity
88
Echothiophate is ___ (short/long) acting
Echothiophate is LONG acting--takes 4-6 weeks for enzyme activity (plasma cholinesterase) to return to normal
89
Phenylephrine is a/an ___ (alpha/beta) adrenergic agonist topically used to ___ (constrict/dilate) pupil
Phenylephrine is an alpha adrenergic agonist topically used to dilate pupil
90
Pilocarpine and acetylcholine are ___ drugs (what class?) used to ___ (dilate/constrict) the pupil; ___cardia and acute ___ have been reported
Pilocarpine and acetylcholine are cholinergic drugs used to constrict the pupil; bradycardia and acute bronchospasm have been reported
91
What is a topical beta blocker used to treat glaucoma?
Timolol
92
Systemic absorption of timolol can cause ___cardia, ___spasm, and ___ exacerbation
Systemic absorption of timolol can cause bradycardia, bronchospasm, and CHF exacerbation
93
Flomax (tamsulosin hydrochloride) has selective ___ (alpha/beta) ___ (agonistic/antagonistic) properties; it binds the iris ___ (constrictor/dilator) muscles, affecting iris ___ and complicates ___ surgery
Flomax (tamsulosin hydrochloride) has selective alpha antagonistic properties; it binds the iris dilator muscles, affecting iris dilation and complicates cataract surgery
94
In those taking flomax, the iris remains floppy even after ___-___ days off therapy
In those taking flomax, the iris remains floppy even after 7-28 days off therapy
95
What is the most common elderly surgery?
Eye surgery
96
Pre-op evaluation for eye surgery--severe HTN leads to postop complications; stage 3 is systolic > ___ or diastolic > ___; reschedule sustained stage 3 HTN client until ___ weeks of antiHTN treatment
stage 3 HTN is systolic > 180 or diastolic > 110; reschedule sustained stage 3 HTN client until 2 weeks of antiHTN treatment
97
Pre-op eval for eye surgery--diabetics--check fasting glucose and use insulin to maintain BS ___-___
Check fasting glucose and use insulin to maintain BS 150-250
98
Pre-op eval for eye surgery--critical results--Na less than ___, greater than ___; K less than ___, greater than ___
Na less than 120, greater than 158; K less than 2.2, greater than 6.2
99
Pre-op eval for eye surgery--critical results--BUN greater than ___
BUN greater than 104
100
Pre-op eval for eye surgery--critical results--serum glucose less than ___, greater than ___
serum glucose less than 46, greater than 484
101
Pre-op eval for eye surgery--critical results--Hct < ___% or > ___%; Hgb < ___ or > ___
Hct < 18% or > 61%; Hgb < 6.6 or > 19.9
102
Pre-op eval for eye surgery--hemorrhage potential is serious in ___ and ___ surgery; intermediate in ___, ___, and ___ transplant; least in ___ surgery
Hemorrhage potential is serious in orbital and oculoplastic surgery; intermediate in vitreoretinal, glaucoma, and corneal transplant; least in cataract surgery
103
Most agree that it is safe to do cataract surgery with patient on warfarin--T/F?
True
104
Facial nerve block is utilized for eye surgery when complete akinesis of ___ is desired
Facial nerve block is utilized for eye surgery when complete akinesis of eyelid is desired (can't squeeze eye, can't squint)
105
Facial nerve blocks ___ muscle
Facial nerve blocks orbicularis oculi muscle
106
What is a major complication of Van Lint, Atkinson, or O'Brien blocks?
Subcutaneous hemorrhage
107
Nadbath Rehman blocks entire trunk of facial nerve; expect lower facial droop postop for several hours; injection is close to what (2) cranial nerves?
Nadbath Rehman blocks entire trunk of facial nerve; expect lower facial droop postop for several hours; injection is close to VAGUS and GLOSSOPHARYNGEAL nerves
108
Nadbath Rehman block is associated with ___ paralysis, ___spasm, dys___, and ___ distress
Nadbath Rehman block is associated with vocal cord paralysis, bronchospasm, dysphasia, and respiratory distress
109
Retrobulbar block involves injection of local anesthetic within the ___
Retrobulbar block involves injection of local anesthetic within the muscle cone
110
What is added to retrobulbar block to speed tissue penetration?
Hyaluronidase (Hydase, Amphadase, Vitrase, Hylenex)
111
Retrobulbar block produces anesthesia of the ___, akinesia of the ___ muscle, and ___tony (drop in IOP from relaxation of ___ muscle and ___ [increased/decreased] production of aqueous humor)
Retrobulbar block produces anesthesia of the globe, akinesia of the extraocular muscle, and hypotony (drop in IOP from relaxation of extraocular muscle and decreased production of aqueous humor)
112
What muscle may NOT be blocked by a retrobulbar block? Why?
Superior rectus muscle because it runs outside the muscle cone
113
How can you tell if the superior rectus muscle was NOT blocked by a retrobulbar block?
Intorsion on downward gaze
114
What is the most common complication of retrobulbar block?
Retrobulbar hemorrhage--watch for OCR
115
What are (2) signs of retrobulbar hemorrhage?
- Proptosis (downward displacement)
| - Subconjunctival ecchymosis
116
Monitoring of ___ is mandatory if retrobulbar hemorrhage occurs
Monitoring of IOP is mandatory if retrobulbar hemorrhage occurs
117
If there is no elevation in IOP from retrobulbar hemorrhage, then surgery may proceed--T/F?
True
118
Retrobulbar hemorrhage--bleeding outside muscle cone is seen as ___ without ___
Retrobulbar hemorrhage--bleeding outside muscle cone is seen as subconjunctival ecchymosis without proptosis
119
RBB--intravascular injection ___ (can/cannot) occur with negative aspiration
RBB--intravascular injection CAN occur with negative aspiration
120
RBB--IV injection is usually of little consequence--T/F?
True because it is such a small dose
121
RBB--arterial injection leads to high brain levels via retrograde flow in internal carotid artery; CNS ___ and ___ are possible, but are usually ___ d/t redistribution
RBB--arterial injection leads to high brain levels via retrograde flow in internal carotid artery; CNS excitation and seizure are possible, but are usually transient d/t redistribution
122
RBB complications--injection into optic nerve sheath (which is continuous with the ___ space) leads to...contralateral ___; ___ation; ___ arrest (occurs within ___ minutes, resolves within ___ hour); vascular ___ from depressant effect on the medulla (total ___)
RBB complications--injection into optic nerve sheath (which is continuous with the subarachnoid space) leads to...contralateral amaurosis (complete lack of vision), obtundation, respiratory arrest (occurs within 20 minutes, resolves within 1 hour), vascular collapse from depressant effect on the medulla (total spinal)
123
Other RBB complications--___ nerve damage; ocular ___ with retinal ___ and vitreous ___; postop ___ from anesthetic myotoxicity (occurs with what local?)
Other RBB complications--optic nerve damage; ocular perforation with retinal detachment and vitreous hemorrhage; postop strabismus from anesthetic myotoxicity (occurs with bupivacaine)
124
RBB complication--postop strabismus from anesthetic myotoxicity = vertical ___ vision that occurs day after surgery, worsening over ___ months; occurs d/t tight ___ rectus muscle
RBB complication--postop strabismus from anesthetic myotoxicity = vertical double vision that occurs day after surgery, worsening over 2 months; occurs d/t tight inferior rectus muscle
125
What are contraindications for RBB?--___ disorders; extreme ___; ___ eye injury
contraindications for RBB--bleeding disorders (d/t risk of RB hemorrhage); extreme myopia (longer globe is more at risk of perforation); open eye injury (b/c pressure of fluid behind eye may force intraocular contents out through wound)
126
Peribulbar blockade is ___ (more/less) safe than retrobulbar block
Peribulbar blockade is more safe than retrobulbar block
127
Compared to RBB, peribulbar blockade involves multiple injections made around eye without entering the ___
Compared to RBB, peribulbar blockade involves multiple injections made around eye without entering the muscular cone
128
Peribulbar blockade has a ___ (shorter/longer) onset time compared to RBB
Peribulbar blockade has a longer onset time compared to RBB (9 to 12 minutes)
129
Peribulbar block offers ___ (more/less) complete akinesia
Peribulbar block offers less complete akinesis
130
Globe perforations have been reported with peribulbar blocks--T/F?
True
131
There is a/an ___ (increased/decreased) likelihood of ecchymosis with peribulbar blocks than RBB
There is an increased likelihood of ecchymosis with peribulbar blocks than RBB
132
Benefits of sub-tenon's block--local anesthetic ___ into retrobulbar space; avoid use of ___; complications ___ (more/less) than RBB and peribulbar block
Benefits of sub-tenon's block--local anesthetic diffuses into retrobulbar space; avoid use of sharp needle; complications less than RBB and peribulbar block
133
What (2) local anesthetics are used topically for eye surgery?
- Tetracaine 0.5%
| - Lidocaine 4%
134
How is the topical given?--two drops of ___ given initially, followed by ___ more doses of ___ or ___ q ___ minutes just before surgery
Two drops of tetracaine given initially, followed by 3 more doses of tetracaine or lidocaine q 5 minutes just before surgery
135
Neither general nor regional anesthesia have shown to be safer for eye surgery--T/F?
True
136
What is the only anesthetic option for ruptured globe?
General ETT is the only choice for ruptured globe
137
Emesis from vagal stimulation, especially after ___ surgery, is common
Emesis from vagal stimulation, especially after strabismus surgery, is common
138
Important to aggressively prevent and treat ___ for eye surgery patients undergoing general anesthesia
Important to aggressively prevent and treat nausea for eye surgery patients undergoing general anesthesia
139
Severe pain post op is unusual after eye surgery, except for what (3) types of eye surgery?
- Scleral buckling
- Enucleation
- Ruptured globe repair
140
Severe pain post-op may indicate IO ___, corneal ___, or other complication
Severe pain post-op may indicate IO hypertension, corneal abrasion, or other complication
141
In certain vitreoretinal procedures, an air bubble is injected into the eye to tamponade the detached ___ to the globe
In certain vitreoretinal procedures, an air bubble is injected into the eye to tamponade the detached retina to the globe
142
Should nitrous be used in vitreoretinal procedures where an air bubble is used? Why?
NO--because nitrous diffuses and causes air bubble expansion, with potential for IOP increase
143
N2O should be d/c'ed ___ minutes before placement of sulfur hexafluoride and avoided for ___ to ___ days after
N2O should be d/c'ed 15 minutes before placement of sulfur hexafluoride and avoided for 7 to 10 days after
144
Another vitreal air agent, perfluoropropane (C3F6), persists for ___
Another vitreal air agent, perfluoropropane (C3F6), persists for weeks
145
How long should N2O be avoided if perfluoropropane (C3F6) is instilled?
Avoid N2O for 1 month after instillation of the agent
146
Open globe surgeries are usually ___
Open globe surgeries are usually emergent, full stomachs
147
Succs can be safely used for induction of anesthesia for open globe injury--T/F?
True--no actual case reports of further eye injury when succs is used
Controversy d/t increase in IOP from succs; actual intubation would probably cause more of an increase in IOP than use of succs if patient is not adequately anesthetized
148
In extraocular procedures, the globe ___ (is/is not) open
In extraocular procedures, the globe is NOT open
149
What is critical for extraocular procedures?
Decreased bleeding; IOP not as critical
150
Extraocular procedures typically have ___ (more/less) pain postop d/t tissue handling and swelling
Extraocular procedures typically have more pain postop d/t tissue handling and swelling
151
What extraocular surgery is done to resection (shorten) and recession (lengthen) the opposite muscle?
Strabismus surgery
152
16% of all eye surgeries are related to a muscle disorder--T/F?
True
153
What drug should be avoided in strabismus surgery?
Succs d/t prolonged response
154
Eyelid surgery--usually done ___; ptosis raises suspicion for ___ disease
Eyelid surgery is usually done local; ptosis raises suspicion for neuromuscular disease
155
What is most important consideration for lacrimal apparatus surgery?
Suction pharynx well!!!
Defectively drained excess tears will drain back into the pharynx
156
Enucleation is done for what (4) reasons?
- Tumor
- Trauma
- Cancer
- Painful eye
157
Watch for ___ during enucleation
Watch for OCR during enucleation
158
What drug is usually avoided for eye surgeries? Why?
Ketamine d/t nystagmus
159
Retinal detachment is a/an ___ (intra/extra) ocular procedure
Retinal detachment is an extraocular procedure
160
Vitrectomy is a/an ___ (intra/extra) ocular procedure
Vitrectomy is an intraocular procedure
161
During vitrectomy, diseased vitreous is removed and replaced by ___; ___ (soft/hard) eye desired; ___ placed
During vitrectomy, diseased vitreous is removed and replaced by balanced salt solution; soft eye desired; air gas bubble placed
162
For retinal detachment/vitreal surgery, patient may be placed in a specific position to enhance reattachment--T/F?
True
163
If gas bubble is used, ___ precautions must be used
If gas bubble is used, nitrous precautions must be used
