Anesthesia Considerations 

Strabismus Surgery 

 

 

Background 

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• Affects 3-5% of the population, most patients are ASA 1 & 2

  • occasional association with syndrome (e.g. Trisomy 21)

• Age ranges anywhere from neonate to teenagers (and older if

• 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

• Limited access to head

• Avoid succinycholine/ketamine (potential for increased IOP)

• Avoid coughing on emergence

• Potential for oculocardiac reflex and resultant bradycardia

  • Risk for sinus arrest

  • Consider sub-Tenon's block at the start of surgery to prevent the reflex

  • Management:

    • notify surgeon to release traction/pressure on globe

    • 10 mcg/kg glycopyrrolate IV bolus 

• High risk for PONV  

  • Especially in patients older than 3

  • Consider:

    • dual-therapy prophylaxis: ondansetron and dexamethasone

    • TIVA

• Relatively painful procedure:

  • Patients will need long-acting opioids (hydromorphone/morphine) post-op

  • Surgeon should perform sub-Tenon's block at the end of surgery

  • Multi-modal analgesia with Tylenol and NSAIDs

• Potential comorbid conditions:

  • Craniosynostosis (Apert/Pfeiffer/Crouzon syndromes)

  • Craniofacial abnormalities (Treacher Collins/Goldenhar syndromes)

  • Trisomy 21

  • Edward's syndrome

• Ocular myopathies rarely associated with malignant hyperthermia

  • Avoid succinycholine

  • Employ temperature monitoring

 

 

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.