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Dear Readers,
Ophthalmic surgery is one of the most frequent surgical procedures requiring anesthesia in developed countries. Perioperative morbidity and mortality rates associated with eye surgery are low. Nevertheless, because patients with cataracts tend to be older and to have serious comorbidities, systematic preoperative evaluation should be performed to consider a patient eligible for surgery. Anesthetic management may contribute to the success or failure of ophthalmic surgery.

Ocular surgery may be performed under topical, local or general anesthesia. Local anaesthesia is more preferred because it is economical, easy to perform and the risk involved is less. Local anaesthesia has a rapid onset of action and provides a dilated pupil with low intraocular pressure.

This issue of Site News explores the Introduction of Anesthesia, Principles and techniques, Anesthesia and Ocular Surgeries. It also brings to you Complications, Guidelines, Awareness, Monitoring, History and Society.



Your feedback will help us improve the newsletter. Please send in your feedback at eyesite@aravind.orgThank You. Have a happy reading.

Regards,
Library Team
The Issue Features...
Ocular Anaesthesia
Vol.11 No.3 May & June 2014
•Introduction
•Ophthalmology and Anaesthesia
•Principles and Techniques
•Anaesthesia and Ocular Surgeries
•Anaesthesia and Complications
•Ophthalmic Agents - Anesthetics
•Guidelines & Awareness
•Anesthesia and Monitoring
•Medico Legal Aspects of Anaesthesia
•History of Ocular Anaesthesia
•Anaesthesia Society

• Past Issues




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  • Local anaesthesia is currently performed for many ophthalmic procedures as it is associated with reduced morbidity and mortality when compared with general anaesthesia. Additional benefits include early patient mobilisation, improved patient satisfaction and reduced hospital stay. A variety of different methods of administration are described which may be broadly divided into 'injections' or 'topical applications'. 'Injection' techniques all involve needle perforation of the peri-orbital skin or conjunctiva and injection of local anaesthetic into the peri-orbital or orbital tissues. Orbital injections are occasionally associated with serious sight or even life-threatening complications. In contrast 'topical' anaesthesia, where local anaesthetic eye drops are applied to the surface of the eye, is non-invasive and has virtually no complications. It is becoming increasingly popular for phacoemulsification cataract surgery although many other procedures may also be performed topically.




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  • ANAESTHESIA IN OPHTHALMOLOGY

  • Apart from surgical skill, the ultimate success of an intraocular operation greatly depends upon the mode of anaesthesia. The purpose of anaesthesia is to relieve pain, anxiety and apprehension and, if possible, to produce muscular relaxation. Emotional states cause a severe, generalized increase of muscular tone, which affects the orbicularis and extraocular muscles and produces a tendency to hold the breath, causing severe congestion. General anaesthesia combined with local akinesia and retrobulbar anaesthesia seems to accomplish this purpose. Another advantage of general anaesthesia is the peace of mind brought to the surgeon who can concentrate on his surgery. Moreover the average surgeons performance is vastly improved when he no longer has to worry about the possible reactions of his patient on the table and when he can plan his technique unhurriedly and carefully. To achieve best results, the anaesthesia must be safe and smooth with minimal postoperative complications.

  • OPHTHALMIC REGIONAL ANAESTHESIA: A REVIEW AND UPDATE

  • Eye surgeries had been performed with little or no anaesthesia for almost a 1000 years. The "Year 1884" was a watershed year for ophthalmic anaesthesia; it was in this year that Carl Koller discovered cocaine hydrochloride as a topical anaesthetic agent for performing eye surgery and Herman Knapp used cocaine for retrobulbar injection and performed enucleation. Various local anesthetic techniques have evolved since then including both akinetic (needle-/cannula-based technique) and non-akinetic (topical anaesthesia) techniques. The advent of clear corneal phacoemulsification combined with foldable intraocular lens brought a resurgence to the non-akinetic technique as a safe and easy form of ocular anaesthesia.

  • ANAESTHESIA OF THE EYE AND PREPARING THE PATIENT FOR SURGERY

  • Anaesthesia aims to produce a pain-free surgical field. When operating on the eye it is also necessary to paralyse the extraocular muscles and the orbicularis oculimuscle which closes the eyelids.




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  • ADMINISTERING AN EYE ANAESTHETIC: PRINCIPLES, TECHNIQUES, AND COMPLICATIONS

  • The trigeminal nerve carries the sensory innervation of the eye and adnexa in three divisions. ophthalmic, maxillary, and mandibular. The sensory fibres of the eye and adnexa are found in the ophthalmic division – with the exception of a portion of the sensory input from the lower lid, which is carried by the maxillary division. Blocking the sensory fibres provides anaesthesia so that no pain is felt.

  • OPHTHALMIC REGIONAL ANAESTHESIA TECHNIQUES

  • There is substantial national and international variation in the conduct of anesthesia for ophthalmic surgical procedures. Ophthalmic regional anesthetic techniques include traditional needle-based blocks, such as intraconal or extraconal injections; sub-Tenon’s blocks which can be accomplished with needles, but are more commonly performed with blunt cannulae; and topical anesthesia. Needle-based techniques are generally safe although rare, serious sightand life-threatening complications may occur. In recent years, a renewed interest in sub-Tenon’s and topical anesthesia has emerged. Currently there is no absolutely safe ophthalmic regional block. It is essential that those who are involved in the care of ophthalmic patients have a thorough knowledge of the approaches employed and their associated risks and benefits. This review article outlines the relevant anatomy, commonly used techniques and their safe performance.

  • ANAESTHESIA FOR OPHTHALMIC SURGERY: PART 1 ANATOMY & PHYSIOLOGY - REGIONAL TECHNIQUES

  • Ophthalmic surgery can be performed under either regional or general anaesthesia. Part I describes the relevant anatomy and physiology for the anaesthetist before discussing regional anaesthetic techniques. Part II will focus on general anaesthesia for eye surgery.




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  • ANAESTHESIA IN OCULAR SURGERY

  • This article aims to provide anoverview of current practice in ocularanaesthesia and an understanding ofthe techniques used.

  • ANAESTHETIC MANAGEMENT IN CATARACT SURGERY

  • The anaesthetic management varies between topical anaesthetic applications, regional blocks to general anaesthesia. The patients’ medical/mental condition and current medications are of prime importance in terms of their implications for anaesthesia. It is also prudent to define and prevent drug interactions of ocular medication that are required duringthe perioperative or postoperative period. The type of intervention and skill of the surgeon are variables that influence the selection of the anaesthetic regimen.

  • CATARACT SURGERY: IS AN ANESTHESIOLOGIST NECESSARY

  • One of the consequences of a tightening economy is that people are forced to consider alternate ways of working that may be faster, simpler and/or more cost-effective. Given that the majority of cataract surgeries are now quick and relatively straight forward outpatient procedures, some surgeons are wondering whether these cases can't be simplified by eliminating the presence of an anesthesiologist or certified registered nurse anesthetist, as surgeons in some countries around the world already do.

  • ANAESTHESIA FOR PAEDIATRIC EYE SURGERY

  • This tutorial has reviewed the general principles of anaesthesia for paediatric eye surgery, as well as considerations for some common procedures.

  • ANESTHESIA FOR OPHTHALMIC SURGERY

  • Anesthesia for Ophthalmic Surgery.ppt provides several unique challenges for the anesthesiologist.




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  • COMPLICATIONS OF LOCAL ANAESTHESIA FOR OPHTHALMIC SURGERY

  • Complications of local anaesthesia for ophthamic surgery may result from the agents used or the block technique itself and, although relatively rate, range from the trivial to the devastating, which may threaten sight or even life.

  • SUB-TENON’S ANAESTHESIA: COMPLICATIONS AND THEIR PREVENTION

  • The advent of a new technique that is considered much safer than previously established one leads to its rapid adoption. This usually leads to the identification of previously unreported complications of the new technique, and a re-assessment of its position in clinical care, which is precisely the state of play with the sub-Tenon’s block. The sub-Tenon’s block was introduced into the clinical practice in early 1990. A systematic recent search of subject headings such as complications of sub-Tenon’s block, subtenon, orbital block, orbital block complications, and orbital anaesthesia was performed in Medline, EMBASE, and Cochrane database. Indeed there are complications of sub-Tenon’s block published as case reports and the exact incidence of these complications is not known.

  • ORBITAL REGIONAL ANESTHESIA: COMPLICATIONS AND THEIR PREVENTION

  • Serious complications following orbital regional anesthesia are rare, but occur following both needle and blunt cannula (sub-Tenon’s) techniques. Each technique of orbital regional anesthesia has its own risk/benefit profile. This article reviews the etiology, risk factors, treatment and prevention of complications of commonly used akinetic orbital blocks. Ophthalmologists and ophthalmic anesthesiologists must be prepared to deal with rare, but serious complications, that can occur with any technique of orbital regional anesthesia.

  • REDUCING CATARACT SURGERY-RELATED COMPLICATIONS

  • In this issue, Puri et al report perforation of globe in 8 patients resulting from peribulbar anaesthesia. The authors noted this complication before or during surgery in 3 cases by observing intraoperative hyphema, very soft eye, or loss of red reflex. In 4 cases diagnosis was established within a week and in one case at 3 weeks after surgery.




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  • LOCAL ANAESTHESIA FOR OPHTHALMIC SURGERY

  • The purpose of these guidelines is to provide information for all members of the ophthalmic team in order to promote safe and effective local anaesthesia for ophthalmic patients. They are intended to apply to practice in the United Kingdom. These guidelines will be reviewed within 5 years of publication.

  • PEDIATRIC ANESTHESIA MANUAL

  • The purpose of the pediatric anesthesia rotation is to provide an initial exposure to a variety of pediatric cases. The length of this rotation, 4 weeks, is enough to allow participation in the care of about 100 patients. Residents on this rotation should be able to develop skills for setting up OR’s for pediatric patients of different ages and should master skills in mask ventilation and intubation of pediatric patients including neonates.

  • AWARENESS DURING ANAESTHESIA

  • This article explores the types, incidence, consequences, causes, management and avoidance of intraoperative awareness.




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  • MONITORING THE ANESTHETIZED PATIENT

  • The administration and monitoring of anesthesia for surgical procedures is a complex and multifaceteds kill that requires both knowledge and practice. The safety of your patient is dependent on your awareness and response to potential problems. A thorough understanding of the principles of anesthetic monitoring and awareness of normal and abnormal patient parameters is crucial to providing safe anesthesia.

  • AN AUDIT OF THE USE OF OPHTHALMIC THEATRE TIME

  • This study assessed how an ophthalmic theatre utilised its resources with a view to increasing efficiency and reducing the unit cost of surgery. It is hoped that this will remove some of the major barriers to the uptake of cataract surgery and encourage other eye units to carry out similar studies.

  • ANESTHESIA MONITORING BY REGISTERED NURSES DURING CATARACT SURGERY: ASSESSMENT OF NEED FOR INTRAOPERATIVE ANESTHESIA CONSULTATION

  • To assess the frequency and risk factors for intraoperative anesthesia consultation when performing cataract surgery monitored by registered nurses.




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  • MEDICOLEGAL ASPECTS OF REGIONAL ANESTHESIA

  • The purpose of this chapter is to present basic medicolegal principles, to report published guidelines that establish professional standards, and to summarize recent publications concerning medicolegal issues specific to the practice of regional anesthesia.Those interested in reading a meticulous dissertation concerning the legal aspects ofmedicine should consult a law text covering that fi eld of jurisprudence. One couldperuse a contemporary textbook of anesthesiology; such publications devote at least one exhaustive chapter to the subject.

  • OPHTHALMIC ANESTHESIA LIABILITY - OMIC

  • OMIC conducted a review of claims and lawsuits related to anesthesia and sedation in order to identify issues that can be modified through proactive risk management. When patients sue physicians for medical malpractice, the entire process of care is scrutinized. Attention to the following aspects of care will promote patient safety and reduce the ophthalmologist’s professional liability exposure.

  • OPHTHALMOLOGY ANESTHESIA SERVICES






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  • ANAESTHESIA FOR EYE SURGERY

  • The history of anesthesia for eye surgery dates back 2,500 years. The earliest authentic writings on the subject were those of Sus'ruta, the ancient Indian surgeon who first described couching—the depression of the cataract into the vitreous—around 600 BC.1 He outlined the use of inhalational anesthesia for this method, and also described aseptic technique




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  • BRITISH OPHTHALMIC ANAESTHESIA SOCIETY

  • The British Ophthalmic Anaesthesia Society is an organisation of Anaesthetists, Ophthalmologists and other clinicians who are committed to sharing education and information which will enable them to provide the highest level of anaesthetic management during ophthalmic surgery

  • OPHTHALMIC FORUM OF INDIAN SOCIETY OF ANAESTHESIOLOGISTS (OFISA)

  • The aim of establishing this forum is to provide a platform for anaesthesiologists, ophthalmologists and clinicians practising ophthalmic anaesthesia to share their experiences to promote a high standard of patient care and to hold continuing medical education programmes and conference once in two years.




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  1. April & May 2013 2013 -Cataract Surgical Monitoring
  2. May & June 2014 2014 -Ocular Anaesthesia
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