Anesthesia For Eye Surgery

Understanding the anesthetic implications and approaches to ophthalmic surgery is very important for providing anesthetic care in the perioperative period. The goals of anesthesia during elective eye surgery should focus on patient safety and providing analgesia to elicit a pain-free experience and create optimal surgical conditions to facilitate the procedure in collaboration with the perioperative staff, including the ophthalmologic surgeons and surgical technicians. It is paramount to minimize risks that may present during eye surgery under anesthesia and sedation while anticipating and managing any potential outcomes associated with eye surgeries. The most common eye surgeries performed today are cataracts, glaucoma, and vitreoretinal surgery. It is estimated that nearly 26 million Americans are suffering from cataracts, and approximately 3.6 million cataract extractions are completed annually, making it the most commonly performed surgical procedure in the united states. Moreover, glaucoma affects nearly 67 million people in the united states, and understanding the concept of intraocular pressure concerning intravenous and volatile anesthetics becomes increasingly important to providing anesthetic care, especially in patients with comorbidities. Another commonly performed ophthalmic surgery is vitreoretinal. The important anesthetic consideration for this surgery would concern the need for general versus local anesthesia and the necessary avoidance of nitrous oxide with intraoperative use of sulfur hexafluoride (SF6).This article aims to understand the anesthetic considerations and implications along with the general and regional anesthetic techniques, including topical, retrobulbar, peribulbar, and sub-Tenon blocks, that can be used to provide anesthesia. The anatomy and physiology will be reviewed as well to provide a complete understanding of the structures of the eye and the important hemodynamic manifestations of the oculocardiac reflex. Management of perioperative complications will be discussed as the adverse events can result in significant life-threatening harm and permanent visual impairments for patients presenting for ophthalmic surgeries. According to the anesthesia closed claims project, eye injury occurred in 3% of all claims in the database, further indicating the importance of protecting and caring for the eyes during anesthesia, especially in mitigating the risk associated with peripheral nerve blocks.