Eye surgery

[badasshairday]

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Kind of random question. Do anesthesiologist's provide anesthetic for eye surgeries?

 

[Gimlet]

Kind of random question. Do anesthesiologist's provide anesthetic for eye surgeries?

Absolutely...lots of MACs for simple eye procedures and cataract operations, but also general anesthetics for the bigger operations and oculoplastics stuff. The ophthalmalogists do retrobulbar blocks sometimes, too, which is cool.

(BAHD, if you do your anesthesia rotation at Froedtert you'll spend some time over at the Eye Institute. Going there on Tuesdays (cataract day) is a great way to get experience starting IVs (15+ each day).

 

[Planktonmd]

Anesthesiologists in many places do peribulbar and retrobulbar blocks in a addition to what has been mentioned above.
It appears that these techniques are not being taught that much anymore though.

 

[aphistis]

Kind of random question. Do anesthesiologist's provide anesthetic for eye surgeries?

Unfortunately. I had two cataracts today that went over three hours each. EACH.

Ophtho does their own blocks here at IU.

 

[jwk]

Unfortunately. I had two cataracts today that went over three hours each. EACH.

Ophtho does their own blocks here at IU.

OMG - I get irritated when they go over 15 minutes.

 

[jwk]

Anesthesiologists in many places do peribulbar and retrobulbar blocks in a addition to what has been mentioned above.
It appears that these techniques are not being taught that much anymore though.

Our group used to do tons of peribulbar blocks for cataracts. No more - for the few that we do, the thought was that although small, the risk associated with doing RBB/PBB far outweighed the minimal payment we get from Medicare, so if the ophthalmologist really wants it, we are happy to provide sedation for them to do it themselves. BTW, the only complication from an RBB/PBB that I've seen personally was one that was done by an ophthalmologist.

Most progressive ophthalmologists, at least those out of training, now go with topical / intracameral lidocaine and MAC for cataracts. Our hospital actually had a lot of people coming in from out of state because we did topical cataracts in the early 80's when very few places were doing them that way. Our cataract procedures run 8-12 minutes, and I've seen some do them in five minutes.

Our vitreo-retinal work is done with a block by the surgeon and/or GA.

 

[badasshairday]

Unfortunately. I had two cataracts today that went over three hours each. EACH.

Ophtho does their own blocks here at IU.

Why would that bother you if it is long? Don't you just need to administer the block and then you are done? Why would you need to stick around for the full 3 hours?

Also what is the difference between the retrobulbar and peribulbar blocks? They look the same to me. And what nerve/nerves are you exactly anesthetizing? What does MAC stand for? Sorry if these are dumb questions, I'm just an M1.

 

[badasshairday]

Lastly, don't patients freak the hell out when you have a long needle going towards there eye? It must have also been unnerving for you guys/gals doing your first peribulbar/retrobulbar block.

 

[Planktonmd]

Why would that bother you if it is long? Don't you just need to administer the block and then you are done? Why would you need to stick around for the full 3 hours?

Also what is the difference between the retrobulbar and peribulbar blocks? They look the same to me. And what nerve/nerves are you exactly anesthetizing? What does MAC stand for? Sorry if these are dumb questions, I'm just an M1.

The difference between a peribulbar and retro bulbar block is basically the depth of the injection:
A peribulbar injection is done using a 2.5 cm needle and the local anesthetic is deposited around the globe without entering the muscle cone.
A retrobulbar block is done deeper with a longer needle and the needle actually penetrates the muscle cone and the medicine is injected behind the globe.
The goal of both blocks is to anesthetize all the motor nerves of the eye (3,4 and 6) and the sensory branches from 5.
The desired result is immobile dilated and anesthetized eye.
The retrobulbar block is usually more effective and requires less volume (2-3 cc).
The retrobulbar carries the risk of optic nerve penetration and a very high intrathecal injection though.
Most people currently do peribulbar blocks.

 

[Arch Guillotti]

Lastly, don't patients freak the hell out when you have a long needle going towards there eye? It must have also been unnerving for you guys/gals doing your first peribulbar/retrobulbar block.

The patients are typically given sedation or brief general anesthesia during the blocks.

 

[badasshairday]

Thank you very much for the responses!

 

[MAC10]

Thank you very much for the responses!

I personally find Optho cases to be the most boring cases only interrupted by brief periods of bradycardia. The only cases I hate worse than eyes are 14 hour neck dissections done with pain in the arse ENTs (ha havent done one since CA-2 year and ill be okay if i never do one again).

 

[huktonfonix]

hmm you seem to have forgotten the middle of the night digital reimplantation

 

[proman]

I'm going to vote for free flaps of any kind, followed by anything eye related.

 

[Green912]

Recently spent two weeks at the eye hospital. Lots of sedation, a couple of GAs, never got to do a block.