Strabismus Surgery
Background
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Affects 3-5% of the population, most patients are ASA 1 & 2
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occasional association with syndrome (e.g. Trisomy 21)
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Age ranges anywhere from neonate to teenagers (and older if
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Surgery requires tightening, lengthening, transposing or shortening the extra-ocular muscles
Considerations
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Potential for perioperative anxiety as patients may require multiple procedures
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Limited access to head
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Avoid succinycholine/ketamine (potential for increased IOP)
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Avoid coughing on emergence
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Potential for oculocardiac reflex and resultant bradycardia
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Risk for sinus arrest
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Consider sub-Tenon's block at the start of surgery to prevent the reflex
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Management:
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notify surgeon to release traction/pressure on globe
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10 mcg/kg glycopyrrolate IV bolus
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High risk for PONV
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Especially in patients older than 3
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Consider:
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dual-therapy prophylaxis: ondansetron and dexamethasone
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TIVA
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Relatively painful procedure:
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Patients will need long-acting opioids (hydromorphone/morphine) post-op
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Surgeon should perform sub-Tenon's block at the end of surgery
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Multi-modal analgesia with Tylenol and NSAIDs
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Potential comorbid conditions:
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Craniosynostosis (Apert/Pfeiffer/Crouzon syndromes)
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Craniofacial abnormalities (Treacher Collins/Goldenhar syndromes)
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Trisomy 21
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Edward's syndrome
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Ocular myopathies rarely associated with malignant hyperthermia
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Avoid succinycholine
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Employ temperature monitoring
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References
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Lewis H, James I. Update on anaesthesia for paediatric ophthalmic surgery. BJA Educ. 2021 Jan;21(1):32-38. doi: 10.1016/j.bjae.2020.09.002. Epub 2020 Nov 5. PMID: 33456972; PMCID: PMC7808067.