Ophthalmol Clin North Am
· 2006 Jun · PMID 16701167
·
Publisher ↗
This article discusses the two types of anesthesia used during ocular surgery and their associated complications.This article discusses the two types of anesthesia used during ocular surgery and their associated complications.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701166
·
Publisher ↗
Debilitating ocular pain poses a significant challenge to the ophthalmologist. When the pain is intractable and the eye has very poor vision and is disfigured, surgical removal of the eye has traditionally been the defin...Debilitating ocular pain poses a significant challenge to the ophthalmologist. When the pain is intractable and the eye has very poor vision and is disfigured, surgical removal of the eye has traditionally been the definitive treatment of choice. Because many people are uncomfortable psychologically with removal of their eye, however painful, and other patients are not good surgical candidates, an alternative to enucleation is sometimes warranted, and injection of a neurolytic substance can often induce long-lasting anesthesia for a blind painful eye. This article reviews a range of options for management of blind painful eye from anesthesia to enucleation.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701165
·
Publisher ↗
The use of succinylcholine in ocular trauma is controversial because it raises intraocular pressure. This article reviews the advantages and disadvantages of succinylcholine and its alternatives, including regional anest...The use of succinylcholine in ocular trauma is controversial because it raises intraocular pressure. This article reviews the advantages and disadvantages of succinylcholine and its alternatives, including regional anesthesia for open globe injuries. Finally, an algorithm is proposed for airway management of patients with penetrating eye injuries, highlighting circumstances where succinylcholine may be the safest muscle relaxant.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701164
·
Publisher ↗
Ophthalmic pathology in infants and children undergoing eye surgery ranges from the rare and atypical to the commonplace. These pathologies include nasolacrimal duct obstruction, strabismus, congenital or traumatically i...Ophthalmic pathology in infants and children undergoing eye surgery ranges from the rare and atypical to the commonplace. These pathologies include nasolacrimal duct obstruction, strabismus, congenital or traumatically induced cataracts, penetrating eye injuries, glaucoma, retinopathy of prematurity, intraorbital tumors, and more. Nasolacrimal duct stenosis, cataracts, and traumatic eye injuries often occur in otherwise healthy pediatric patients; however, many ophthalmopathies can be associated with other congenital disorders that may have important anesthesia implications. In this article, we will review pertinent anesthesia issues within the context of various ophthalmic diseases.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701163
·
Publisher ↗
Familiarity with facial anatomy, anesthetic agents, and techniques allows the surgeon to maximize his or her surgical success. Reduction of perioperative complications such as an uncooperative or agitated patient may be...Familiarity with facial anatomy, anesthetic agents, and techniques allows the surgeon to maximize his or her surgical success. Reduction of perioperative complications such as an uncooperative or agitated patient may be reduced with proper anesthesia techniques. This ultimately leads to higher success rates and increased patient and physician satisfaction.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701162
·
Publisher ↗
Injections of local anesthetic behind the globe could potentially damage the optic nerve, resulting in visual field defects or even blindness. Glaucoma patients may be at increased risk of this occurring, because of incr...Injections of local anesthetic behind the globe could potentially damage the optic nerve, resulting in visual field defects or even blindness. Glaucoma patients may be at increased risk of this occurring, because of increased susceptibility to pressure/ischemic damage. In extreme cases, this may manifest as visual field "wipe-out." Because of these concerns, "newer" techniques of anterior placement of anesthetic have been promoted, including subconjunctival, anterior sub-Tenon's, topical, and intracameral anesthesia. There remains some controversy regarding the effect of different anesthesia techniques on complication and failure rates for glaucoma surgery.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701161
·
Publisher ↗
The vast majority of vitreoretinal procedures can be safely, comfortably, and efficiently performed under local anesthesia with minimal sedation. Compared with general anesthesia, properly performed monitored local anest...The vast majority of vitreoretinal procedures can be safely, comfortably, and efficiently performed under local anesthesia with minimal sedation. Compared with general anesthesia, properly performed monitored local anesthesia offers the patient an increased level of safety, reduced recovery times, and prolonged postoperative pain relief. Nonetheless, the choice of anesthesia technique must be based on the needs of the patient, the requirements of the surgeon, and the skills of the anesthesia provider, ever keeping in mind that our ultimate goal is a satisfied patient with a good visual outcome.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701160
·
Publisher ↗
Advances in cataract surgery techniques have presented surgeons with new options for ocular anesthesia. As cataract removal has become faster, safer, and less traumatic, the need for akinesia and anesthesia has declined...Advances in cataract surgery techniques have presented surgeons with new options for ocular anesthesia. As cataract removal has become faster, safer, and less traumatic, the need for akinesia and anesthesia has declined significantly. General anesthesia or retrobulbar block have largely been replaced with other safer and equally effective means of local anesthesia. These newer and less invasive methods have reduced the potential for catastrophic surgical complications, increased the efficiency of cataract surgery, and hastened the process of visual rehabilitation. Today there are numerous modes of anesthesia from which a surgeon can choose. This article reviews the current choices for ocular anesthesia, compares their efficacies, and provides a framework, helping to select the most appropriate type of anesthesia for each patient.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701159
·
Publisher ↗
Orbital regional anesthesia is a useful and safe modality for providing excellent operating conditions for the surgeon and painless, pleasant circumstances for the patient. It is especially suited for patients who are ex...Orbital regional anesthesia is a useful and safe modality for providing excellent operating conditions for the surgeon and painless, pleasant circumstances for the patient. It is especially suited for patients who are extremely sensitive and who could not tolerate topical anesthesia or a sub-Tenon's block without deep sedation. Both intraconal and extraconal techniques can be used safely and effectively if proper precautions are taken to enter the safest areas of the orbit and to avoid the vascular areas and the deep orbit where structures are tightly packed and thus more easily harmed. Thorough knowledge of orbital anatomy and understanding of the globe-orbit relationship of every patient are necessary to perform this form of regional anesthesia. In addition, knowledge of the effects and side effects of the anesthetics and adjuvants is also required.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701158
·
Publisher ↗
The sub-Tenon's anesthesia block was reintroduced into clinical practice in the early 1990s as a simple, effective, and safe alternative to needle blocks. The technique has remained simple and effective but has evolved....The sub-Tenon's anesthesia block was reintroduced into clinical practice in the early 1990s as a simple, effective, and safe alternative to needle blocks. The technique has remained simple and effective but has evolved. Although still very unusual, both sight- and life-threatening complications have occurred. To safely perform the block, detailed knowledge of anatomy and methods for administering anesthesia are essential.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701157
·
Publisher ↗
This article will help clinicians to be aware of their choices of local anesthetic solutions before they make their ocular anesthetic plan based on the specific requirements of the patient, the surgical procedure, and th...This article will help clinicians to be aware of their choices of local anesthetic solutions before they make their ocular anesthetic plan based on the specific requirements of the patient, the surgical procedure, and the properties of the local anesthetic. Choices of local anesthetic solutions and additives for both topical anesthesia and conduction blockade are discussed.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701156
·
Publisher ↗
Sedation/analgesia for ophthalmologic surgery is safe and effective. Ideal sedation can be achieved by careful intravenous titration while monitoring the effect of the appropriate sedative and analgesic agents. The choic...Sedation/analgesia for ophthalmologic surgery is safe and effective. Ideal sedation can be achieved by careful intravenous titration while monitoring the effect of the appropriate sedative and analgesic agents. The choice of sedation/analgesia strategy should be based on patient preference and the assessment of risk for adverse events. Thorough preoperative screening and preparation of the patient is most important in obtaining cooperation and patient acceptance.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701155
·
Publisher ↗
Skillful anesthetic management is integral to optimal outcomes after ophthalmic surgery. Although the majority of ophthalmic operations in the United States are performed with local anesthetic techniques, nonetheless gen...Skillful anesthetic management is integral to optimal outcomes after ophthalmic surgery. Although the majority of ophthalmic operations in the United States are performed with local anesthetic techniques, nonetheless general anesthesia may be either necessary or advisable in several challenging circumstances. Ophthalmic patients are often at the extremes of age, and not uncommonly have extensive associated systemic or metabolic diseases. Because the complications of ophthalmic anesthesia can be vision threatening or life threatening, it is imperative that the ophthalmologist and the anesthesiologist understand the complex and dynamic interaction among patient diseases, anesthetic agents, ophthalmic drugs, and surgical manipulation. Effective communication and planning among all involved are essential to safe and efficient perioperative care.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701154
·
Publisher ↗
The prevention of complications during and after procedures is the most important goal of preoperative evaluation. Several studies have proven the utility of a patient history and physical examination when making a diagn...The prevention of complications during and after procedures is the most important goal of preoperative evaluation. Several studies have proven the utility of a patient history and physical examination when making a diagnosis. This article discusses preoperative testing and risk assessment as well as management for various conditions that pose challenges to anesthesia and or surgery.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701153
·
Publisher ↗
Local anesthesia is a common technique used to provide anesthesia for ocular surgical procedures. Despite improvements in operative conditions, there is still the potential for complications, both local and systemic, dur...Local anesthesia is a common technique used to provide anesthesia for ocular surgical procedures. Despite improvements in operative conditions, there is still the potential for complications, both local and systemic, during routine procedures. This article discusses the physiology of neuronal function, the chemistry of various local anesthetic agents, and the pathogenesis of toxicity. It is vital for the practitioner to have thorough knowledge of these subjects in order to reduce risks when performing ophthalmic procedures.
Ophthalmol Clin North Am
· 2006 Jun · PMID 16701152
·
Publisher ↗
Each surgical procedure places unique demands on the anesthesiologist to create surgical anesthesia with minimal physiologic trespass on the patient as well as the surgical repair. In surgery of the eye, the quest for an...Each surgical procedure places unique demands on the anesthesiologist to create surgical anesthesia with minimal physiologic trespass on the patient as well as the surgical repair. In surgery of the eye, the quest for an anesthetic that does not harm the eye or the patient can be a challenge. The removal of cataracts is one of the most frequently performed operations in the United States, and the majority of patients requiring the procedure are elderly and often have other significant medical conditions.
Ophthalmol Clin North Am
· 2006 Mar · PMID 16500536
·
Publisher ↗
If presbyopia is caused by hardening of the crystalline lens, replacing it with a material with mechanical properties similar to the young crystalline lens should restore accommodative ability. Such a silicone material h...If presbyopia is caused by hardening of the crystalline lens, replacing it with a material with mechanical properties similar to the young crystalline lens should restore accommodative ability. Such a silicone material has been developed. Refilling the capsular bag with this material results in 3 to 5 D of accommodation in primates in response to pilocarpine.
Ophthalmol Clin North Am
· 2006 Mar · PMID 16500535
·
Publisher ↗
The light adjustable lens (LAL) is an innovative intraocular lens optic composed of partially polymerized macromers with an appropriately bonded photosensitizer. The injectable technology and multifocality associated wit...The light adjustable lens (LAL) is an innovative intraocular lens optic composed of partially polymerized macromers with an appropriately bonded photosensitizer. The injectable technology and multifocality associated with the LAL can produce precise refractive correction and, it is hoped, the type of accommodative range that is taken for granted during youth. Combining these technologies with a lens material that behaves like the crystalline lens of 25-year-old could precisely return near and distance vision to older adults.
Ophthalmol Clin North Am
· 2006 Mar · PMID 16500534
·
Publisher ↗
The NuLens intraocular lens (IOL) uses a new optomechanical concept to generate a wide range of dioptric power from minimal movements of the ciliary apparatus during accommodative effort. Basic study of the concept of op...The NuLens intraocular lens (IOL) uses a new optomechanical concept to generate a wide range of dioptric power from minimal movements of the ciliary apparatus during accommodative effort. Basic study of the concept of optomechanics in the primate eye led to successful construction and implantation of functioning IOL prototypes.
Ophthalmol Clin North Am
· 2006 Mar · PMID 16500533
·
Publisher ↗
The Sarfarazi accommodative intraocular lens, currently in clinical studies, is a single continuous silicon accommodative lens with dual optics and three haptics that mimic the action of the natural lens by using the con...The Sarfarazi accommodative intraocular lens, currently in clinical studies, is a single continuous silicon accommodative lens with dual optics and three haptics that mimic the action of the natural lens by using the contraction and relaxation of ciliary muscles. The lenses have been implanted in the eyes of patients. There have been no surgical or patient complications related to the lens, and its safety has been clearly demonstrated. Patient acceptance of the lens is excellent. Clinical enrollment will continue to expand.