Applied Anesthesia

Abstract

Anesthesia for oculoplastic surgery varies depending on the requirements of the surgery. Topical application, local infiltration, regional nerve block, and systemic anesthesia are each appropriate for various oculoplastic procedures. Limited surgery of the ocular surface can be performed under topical application of proparacaine or tetracaine eye drops. Anesthesia of the eyelid skin can be achieved with topical application of preparations designed to optimize penetration of keratinized epithelium, including eutectic mixture of local anesthetics, liposomal lidocaine, microsomal lidocaine, or compounded mixtures of anesthetic agents. Local infiltration by subcutaneous injection of lidocaine, procaine, mepivacaine, or bupivacaine is widely used for oculoplastic procedures. Allergy to the ester-type anesthetic procaine is common but does not produce a cross-sensitivity to the amide-type anesthetics lidocaine, mepivacaine, and bupivacaine. Bupivacaine has the advantage of producing longer-lasting anesthesia. Periorbital nerve blocks with these same injectable agents can produce wide regional anesthesia in that nerve’s area of distribution. Systemic anesthesia is preferable or required for more invasive procedures. The four objectives of systemic anesthesia, analgesia, anxiolysis, sedation/hypnosis, and amnesia can be met with either general inhalational anesthesia or monitored anesthesia care. Propofol, benzodiazepines, and opioids can be used in various combinations to achieve these objectives.