Skip to main content
SpringerLink
Log in

Damage Control Ophthalmology: Anesthesia Considerations

  • Chapter
  • First Online:
Ophthalmology in Military and Civilian Casualty Care

  • 270 Accesses

Abstract

Safe and effective anesthetic management of ocular trauma remains an important skillset for the military anesthesiologist. Integral to this is a familiarity with ocular anatomy and physiology, particularly the factors affecting intraocular pressure. While regional and topical anesthesia is useful for minor eye procedures, general endotracheal anesthesia (GETA), particularly in the likely setting of accompanying facial trauma, remains the standard of care for most serious ocular trauma cases. Performing a general anesthetic for eye trauma, especially an open globe, requires a careful balance between creating ideal operating conditions, safeguarding the airway, and preventing the further deterioration of already compromised vision.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ABC:

Airway breathing circulation

ASA:

American Society of Anesthesiologists

BETTS:

Birmingham Eye Trauma Terminology System

cc:

cubic centimeter

CN:

Cranial nerve

ETT:

Endotracheal tube

FDP:

Face-down position

GETA:

General endotracheal anesthesia

IED:

Improvised explosive device

IOP:

Intraocular pressure

JTTR:

Joint Theater Trauma Registry

LA:

Local anesthesia

MARCH:

Massive hemorrhage, airway, respiration, circulation, head/hypothermia

mL:

milliliter

NDMR:

Nondepolarizing muscle relaxant

NPO:

nil per os (nothing by mouth)

OCR:

Oculocardiac reflex

PBB:

Peribulbar block

RBB:

Retrobulbar block

USA:

United States of America

References

  1. Owens BD, Kragh JF, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. J Trauma. 2008;64(2):295–9.

    Article  Google Scholar 

  2. Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A standardized classification of ocular trauma. Ophthalmology. 1996;103(2):240–3.

    Article  CAS  Google Scholar 

  3. Kuhn F, Morris R, Witherspoon CD. Birmingham Eye Trauma Terminology (BETT): terminology and classification of mechanical eye injuries. Ophthalmol Clin N Am. 2002;15(2):139–43.

    Article  Google Scholar 

  4. Viegas OJ, Ravindran RS, Shumacker CA. Gastric fluid pH in patients receiving sodium citrate. Anesth Analg. 1981;60(7):521–3.

    Article  CAS  Google Scholar 

  5. Gan TJ, Meyer TA, Apfel CC, et al. Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 2007;105(6):1615–28.

    Article  Google Scholar 

  6. Henzi I, Walder B, Tramèr MR. Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. Br J Anaesth. 1999;83(5):761–71.

    Article  CAS  Google Scholar 

  7. New York School of Regional Anesthesia [Internet]. Ripart J, Mehrige K, Rocca RD. Local & Regional Anesthesia for Eye Surgery [cited 2018 Jan 10]. Available from: https://www.nysora.com/local-regional-anesthesia-for-eye-surgery.

  8. Wang L, Shankarappa SA, Tong R, et al. Topical drug formulations for prolonged corneal anesthesia. Cornea. 2013;32(7):1040–5.

    Article  Google Scholar 

  9. Atkinson WS. Retrobulbar injection of anesthetic within the muscular cone. Arch Ophthalmol. 1936;16:494–503.

    Article  Google Scholar 

  10. Knapp H. On cocaine and its use in ophthalmic and general surgery. Arch Ophthalmol. 1884;13:402.

    Google Scholar 

  11. Liu C, Youl B, Moseley I. Magnetic resonance imaging of the optic nerve in extremes of gaze. Implications for the positioning of the globe for retrobulbar anaesthesia. Br J Ophthalmol. 1992;76(12):728–33.

    Article  CAS  Google Scholar 

  12. Katsev D, Drews RC, Rose BT. Anatomic study of retrobulbar needle path length. Ophthalmology. 1989;96:1221–4.

    Article  CAS  Google Scholar 

  13. Riad W, Ahmed N. Single injection peribulbar anesthesia with a short needle combined with digital compression. Anesth Analg. 2008;107(5):1751–3.

    Article  Google Scholar 

  14. Warner KJ, Cuschieri J, Jurkovich GJ, Bulger EM. Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury. J Trauma. 2009;67(1):45–50.

    Article  CAS  Google Scholar 

  15. Fields AM, Rosbolt MB, Cohn SM. Induction agents for intubation of the trauma patient. J Trauma. 2009;67(4):867–9.

    Article  Google Scholar 

  16. Bruder EA, Ball IM, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. 2015;1:7. https://doi.org/10.1002/14651858.CD010225.pub2.

  17. Wadia S, Bhola R, Lorenz D, Padmanabhan P, Gross J, Stevenson M. Ketamine and intraocular pressure in children. Ann Emerg Med. 2014;64(4):385–8.

    Article  Google Scholar 

  18. Drayna PC, Estrada C, Wang W, Saville BR, Arnold DH. Ketamine sedation is not associated with clinically meaningful elevation of intraocular pressure. Am J Emerg Med. 2012;30(7):1215–8.

    Article  Google Scholar 

  19. Yoshikawa K, Murai Y. The effect of ketamine on intraocular pressure in children. Anesth Analg. 1971;50(2):199–202.

    Article  CAS  Google Scholar 

  20. Mirakhur RK, Elliott P, Shepherd WF, Archer DB. Intra-ocular pressure changes during induction of anaesthesia and tracheal intubation. A comparison of thiopentone and propofol followed by vecuronium. Anaesthesia. 1988;43(Suppl):54–7.

    Article  CAS  Google Scholar 

  21. Khosravi MB, Lahsaee M, Azemati S, Eghbal MH. Intraocular pressure changes after succinylcholine and endotracheal intubation: a comparison of thiopental and propofol on IOP. Indian J Ophthalmol. 2007;55(2):164.

    Article  CAS  Google Scholar 

  22. Dillon JB, Sabawala P, Taylor DB, Gunter R. Action of succinylcholine muscles and intraocular pressure. Anesthesiology. 1957;18:44–9.

    Article  CAS  Google Scholar 

  23. Lincoff HA, Breinin GM, Devoe AG. The effect of succinylcholine on the extraocular muscles. Am J Ophthalmol. 1957;43:440–4.

    Article  CAS  Google Scholar 

  24. Vinik HR. Intraocular pressure changes during rapid sequence induction and intubation: a comparison of rocuronium, atracurium, and succinylcholine. J Clin Anesth. 1999;11(2):95–100.

    Article  CAS  Google Scholar 

  25. Cook JH. The effect of suxamethonium on intraocular pressure. Anaesthesia. 1981;36(4):359–65.

    Article  CAS  Google Scholar 

  26. Edmondson L. Intraocular pressure and suxamethonium. Br J Anaesth. 1997;79(1):146.

    Article  CAS  Google Scholar 

  27. Wynands JE, Cromwell DE. Intraocular tension in association with succinylcholine and endotracheal intubation: a preliminary report. Can Anaesth Soc J. 1960;7:39–43.

    Article  CAS  Google Scholar 

  28. Holloway KB. Control of the eye during general anaesthesia for intraocular surgery. Br J Anaesth. 1980;52(7):671–9.

    Article  CAS  Google Scholar 

  29. Green K, Luxenberg MN. Consequences of eyelid squeezing on intraocular pressure. Am J Ophthalmol. 1979;88(6):1072–7.

    Article  CAS  Google Scholar 

  30. Libonati MM, Leahy JJ, Ellison N. The use of succinylcholine in open eye surgery. Anesthesiology. 1985;62(5):637–40.

    Article  CAS  Google Scholar 

  31. Vachon CA, Warner DO, Bacon DR. Succinylcholine and the open globe. Tracing the teaching. Anesthesiology. 2003;99(1):220–3.

    Article  Google Scholar 

  32. Berkow L. Rapid Sequence Induction and Intubation (RSII) for anesthesia [internet]. Wolters Kluwer; c2017 [updated 2017 Aug 29]. Available from: https://www.uptodate.com/contents/rapid-sequence-induction-and-intubation-rsii-for-anesthesia.

  33. Murphy DF. Anesthesia and intraocular pressure. Anesth Analg. 1985;64(5):520–30.

    Article  CAS  Google Scholar 

  34. Bridion package insert. Merck Sharp & Dohme, a subsidiary of Merck & Co., Inc. Whitehouse Station, revised 06/2017.

    Google Scholar 

  35. Rocuronium package insert. Saint-Laurent: Hospira Healthcare Corporation; 2015.

    Google Scholar 

  36. Yi C, Jee D. Influence of the anasthetic depth on the inhibition of the oculocardiac reflex during sevoflurane anesthesia for pediatric strabismus surgery. Br J Anaesth. 2008;101(2):234–8.

    Article  CAS  Google Scholar 

  37. Awad K, Ahmed H, Abushouk AI, Al Nahrawi S, Elsherbeny MY, Mustafa SM, Attia A. Dexamethasone combined with other antiemetics versus single antiemetics for prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy: an updated systematic review and meta-analysis. Int J Surg. 2016;36(Pt A):152–63.

    Article  Google Scholar 

  38. Kranke P, Eberhart LH, Roewer N, Tramèr MR. Pharmacological treatment of postoperative shivering: a quantitative systematic review of randomized controlled trials. Anesth Analg. 2002;94(2):453–60.

    Article  CAS  Google Scholar 

  39. Mirakhur RK, Elliott P, Shepherd WF, McGalliard JN. Comparison of the effects of isoflurane and halothane on intraocular pressure. Acta Anaesthesiol Scand. 1990;34(4):282–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. COL (RET), MC, Colorado Army National Guard, Department of Anesthesiology, Denver Health Medical Center, Denver, CO, USA

    Colonel Mark H. Chandler

Authors
  1. Colonel Mark H. Chandler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Colonel Mark H. Chandler .

Editor information

Editors and Affiliations

  1. Lieutenant Colonel, US Army Reserve San Antonio Military Medical Center, San Antonio, TX, USA

    Christopher J. Calvano

  2. Brigadier General, US Army Retired Children’s Hospital of Colorado, Aurora, CO, USA

    Robert W. Enzenauer

  3. Colonel, US Army Retired Ophthalmology Service, JBSA Fort Sam, Houston, TX, USA

    Anthony J. Johnson

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Chandler, C.M.H. (2019). Damage Control Ophthalmology: Anesthesia Considerations. In: Calvano, C., Enzenauer, R., Johnson, A. (eds) Ophthalmology in Military and Civilian Casualty Care. Springer, Cham. https://doi.org/10.1007/978-3-030-14437-1_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-14437-1_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-14435-7

  • Online ISBN: 978-3-030-14437-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation