Cataract and Refractive Surgery. Uveitis and Immunological Disorders. Vitreo- retinal Surgery. Medical Retina. Oculoplastics and Orbit. Pediatric Ophthalmology .
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This book arrived on time and in good condition. This book has a physiological and clinical approach to the topic and perhaps not as detailed on the techniques. If interested in the recent literature review on the topic without significant detail on how-to then this is a very nice simple source. One person found this helpful 2 people found this helpful. Feedback If you have a question or problem, visit our Help pages. If you are a seller for this product and want to change product data, click here you may have to sign in with your seller id.
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Vitreoretinal Surgery - Procedures
English Choose a language for shopping. Track your recent orders. View or change your orders in Your Account. Please try again later. This book arrived on time and in good condition. This book has a physiological and clinical approach to the topic and perhaps not as detailed on the techniques. If interested in the recent literature review on the topic without significant detail on how-to then this is a very nice simple source.
One person found this helpful 2 people found this helpful.
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Amazon Music Stream millions of songs. The oculocardiac reflex OCR is very rare under regional anesthesia. A retrobulbar block RBB can be achieved by injecting a small volume of local anesthesia mL inside the muscular cone. This type of anesthesia has a faster onset and higher success rate than peribulbar block PBB. The potential risks of an RBB include perforation of the globe, injury to the rectus muscles, needle penetration of optic nerve sheath, intravenous injection, intra-arterial injection, retrobulbar hematoma, and OCR elicited by injection.
Remember that injections of local anesthesia intravascularly [venous or arterial] may lead to complications including cardiac rhythm disturbances and even cardiac arrest. A PBB requires introducing the needle into the extraconal space and may reduce the risk of injury to major structures in the intraconal space but at the cost of a slightly lower success rate. The benefits of general anesthesia include a secure airway, complete control of the patient, and no risk of globe perforation or retrobulbar hemorrhage.
General anesthesia is appropriate for combative or delirious patients, as well as pediatric patients. The drawbacks of general anesthesia include changes in hemodynamics and a prolonged recovery. Patients are also prone to PONV. The choice of technique reflects a balanced judgment of patient safety, cooperation of the patient, surgical difficulty, and the length of the procedure. Regional anesthesia has benefits of fewer episodes of hemodynamic fluctuation, freedom from hormonal stress response associated with general anesthesia, less postoperative pain, potential reduction in perioperative rate of DVT and PONV, patient with pulmonary disease may benefit from maintaining their own breathing, full mental status is retained, fast recovery, and no risk of MH.
With these caveats in mind, it seems prudent to avoid general anesthesia if possible. If the surgery is performed under local anesthesia, a calm, motionless, and cooperative patient is the key for the procedure. If the procedure is performed under general anesthesia, a smooth induction with a stable IOP, avoidance or treatment of OCR, and a smooth emergence are essential.
The goal is to maintain a motionless field intraoperatively. This can be accomplished by using inhalational anesthesia, muscle relaxants, and remifentanil or propofol infusions. Unexpected patient movement during the delicate microscopic retinal repair may result in loss of vision. Therefore, deep inhalational anesthesia, supplemented with intermediate-acting muscle relaxant or remifentanil infusions, is recommended during the intraocular procedures.
The OCR may be initiated by surgical traction on the extrinsic eye muscle or direct eye pressure, and this reflex may cause bradycardia and asystole. The OCR can be treated by cessation of the surgical stimulus, IV atropine, or regional anesthesia [orbital block]. Another potential complication is venous air embolism VAE during air tamponade of the vitreous cavity with simultaneously opened choroidal vessels.
Anesthesiologists should be aware that ocular air fluid exchange is not completely safe and may even be fatal especially for patients with patent foramen ovale PFO. Paradoxical air embolism can cause obstruction of coronary and cerebral arteries. Stage 1 or stage 2 recovery is appropriate following this procedure, depending on the patient's condition. Most patients can be discharged home in a few hours.
Postoperative complications such as delirium and postoperative DVT and pulmonary embolism are very, very rare if the procedure is performed under local anesthesia. Stoelting, R, Dierdorf, SF. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. What is the urgency of the surgery? What is the risk of delay in order to obtain additional preoperative information?
What are the implications of co-existing disease on perioperative care? Pulmonary Perioperative evaluation Perioperative risk reduction strategies c.
Renal-GI Perioperative risk reduction strategies Perioperative risk reduction strategies d. Are there medications commonly seen in patients undergoing this procedure and for which should there be greater concern? What should be recommended with regard to continuation of medications taken chronically? How to modify care for patients with known allergies - j. Latex Allergy - k. Does the patient have any antibiotic allergies? Does the patient have a history of allergy to anesthesia? What laboratory tests should be obtained and has everything been reviewed?
What are the options for anesthetic management and how to determine the best technique? What is the author's preferred method of anesthesia technique and why? What prophylactic antibiotics should be administered? What do I need to know about the surgical technique to optimize my anesthetic care? What can I do intraoperatively to assist the surgeon and optimize patient care?
Vitreoretinal Surgery - Procedures
If the patient is intubated, are there any special criteria for extubation? Postoperative management What analgesic modalities can I implement? What level bed acuity is appropriate? What are common postoperative complications, and ways to prevent and treat them? What the Anesthesiologist Should Know before the Operative Procedure Anesthesia management plays a pivotal role in vitreoretinal surgery.
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Preoperative evaluation Patients presenting for vitreoretinal surgery tend to be very young or very old. Cardiovascular system Most vitreoretinal procedures are not urgent and are elective in nature. Pulmonary Perioperative evaluation The perioperative evaluation of COPD and reactive airways disease asthma includes a careful clinical history, including pack-year history of smoking, assessment of the severity of disease, and frequency of exacerbations, emergency department visits, hospitalization, ICU admission and intubation, recent steroid therapy, oxygen requirements, and medication regimen.
Perioperative risk reduction strategies These strategies for COPD include continuing current pulmonary medications. Renal-GI Patients with advanced age and a history of diabetes may present with diminished renal function and delayed renal drug clearance. Perioperative risk reduction strategies These include avoiding potential drugs that are toxic to the kidneys and rehydrating dehydrated patients prior to induction of anesthesia.
Perioperative risk reduction strategies These strategies for gastrointestinal complications include the prophylactic use of gastric volume-reducing strategies, rapid sequence intubation [if indicated], and antacid medications The effects of succinycholine on IOP are controversial, but there is evidence that succinylcholine may cause further eye injury. Neurologic Patients with unstable conditions, such as transient ischemic attacks and stroke, should be stabilized prior to surgery.
Endocrine Patients with retinal disease frequently have a history of diabetes. How to modify care for patients with known allergies - Allergic reactions to local anesthesia are very rare and questioning the patient for histories of allergy needs to be done routinely. Latex Allergy - If the patient has a sensitivity to latex e. For patients with penicillin allergy, use clindamycin or vancomycin. Complete blood count and electrolyte tests are recommended in older patients. Potassium levels should be obtained for patients using a diuretic and hemodialysis patients.
Regional anesthesia Most vitreoretinal surgery can be done under local anesthesia, provided patients are able to lie flat without movement for the duration of surgery, have no uncontrollable cough or movement, have no language barrier, and are able to communicate with the surgeon and anesthesia staff. General Anesthesia The benefits of general anesthesia include a secure airway, complete control of the patient, and no risk of globe perforation or retrobulbar hemorrhage.
Monitored Anesthesia Care Monitored anesthesia care is not appropriate for vitreoretinal procedures. Antibiotics are not routinely required for ophthalmic surgery. Deep extubation should be performed, if possible, to prevent coughing on the endotracheal tube. Postoperatively, oral pain medications may be provided, as well as intravenous pain medications. Powered By Decision Support in Medicine. Does It Increase Bleeding Risk?
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