ABSTRACT
Regional anesthesia for ophthalmic procedures has changed significantly in the past ten years. Phacoemulsification for cataract surgery through corneal microincisions, soft foldable lenses and topical anesthesia simplify surgery such that most operations can be performed on an outpatient basis. Some anesthetic blocks are performed by either anesthesiologists or ophthalmologists, who should understand the advantages and disadvantages for each patient. This review discusses anatomical aspects of interest to the anesthesiologist, the main techniques used and anesthetic innovations, complications and certain controversies such as management of the patient who is taking medications that alter hemostasis, the withdrawal of hyaluronidase in some countries and the systematic ordering of tests before the procedure.
Subject(s)
Anesthesia, Conduction , Anesthesia, Local , Ophthalmologic Surgical Procedures , Adjuvants, Anesthesia/administration & dosage , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods , Anesthesia, Local/adverse effects , Anesthesia, Local/methods , Anesthetics/administration & dosage , Blepharoptosis/etiology , Eye/anatomy & histology , Humans , Orbit/anatomy & histology , Vision Disorders/etiologyABSTRACT
A 19-year-old man with congenital cyanotic heart disease experienced subarachnoid bleeding from a ruptured cerebral aneurysm. Immediate rebleeding with disordered hemostasis caused by prophylactic anticoagulation treatment was the cause of death. Medical progress in repairing congenital heart disease or attenuating its effects has increased the life expectancy of such patients. Anesthesiologists who are not specialized in this area may find themselves assuming responsibility for these patients during non-cardiac surgery of greater or lesser extension.
Subject(s)
Aneurysm, Ruptured/complications , Anticoagulants/adverse effects , Dicumarol/adverse effects , Heart Septal Defects, Ventricular/surgery , Intracranial Aneurysm/complications , Intraoperative Complications/chemically induced , Pulmonary Atresia/surgery , Subarachnoid Hemorrhage/chemically induced , Adult , Aneurysm, Ruptured/surgery , Cyanosis , Encephalocele/etiology , Fatal Outcome , Humans , Intracranial Aneurysm/surgery , Intracranial Hypertension/complications , Male , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Prothrombin/adverse effects , Prothrombin/therapeutic use , Recurrence , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgery , Thromboembolism/prevention & controlABSTRACT
We report two cases of acute pulmonary edema occurring in healthy patients during vitreoretinal surgery. The adverse systemic effects of conjunctival phenylephrine are discussed, along with constraints on its clinical use and the concentration that should be used.
