As far as I know, peds strabismus surgery is generally done with LMAs. Aren't you terrified of the kid moving and getting his eye literally poked out?
Just to give a little perspective, I go once or twice a year with a charity group where we do 50-60 strabismus cases/day. The surgeon is not whiny and fast. The technique we use is zofran ODT in preop, mask sevo—>deep, eye drops, lma in, +-intranasal fentanyl, IM toradol, surgery, local. For larger patients (teens) we will start IV’s but smaller kids don’t even get an IV. The whole process takes about 10-15min per case.
no because non cardiac kids tolerate being deep very well.As far as I know, peds strabismus surgery is generally done with LMAs. Aren't you terrified of the kid moving and getting his eye literally poked out?
no because non cardiac kids tolerate being deep very well.
We tube ours. The LMA sits too much in the field, just pop a RAE in and make your day easier.
Hmmm, doesn't sound much different than doing ear tubes - we don't do IVs on those kids, and most of us do it with a mask and not an LMA. Although I guess I'd be at least a little concerned about not having IV access if that oculocardiac reflex decides to show up.no iv sounds dicey
The no IV is interesting for kids. I suppose if the case is really only 10-15 mins, then skipping the IV can really save time. I don’t think it would fly in my hospital because the PACU nurses would make a big deal out of it. We typically don’t even wake any kids up deep because of the PACU staff.Hmmm, doesn't sound much different than doing ear tubes - we don't do IVs on those kids, and most of us do it with a mask and not an LMA. Although I guess I'd be at least a little concerned about not having IV access if that oculocardiac reflex decides to show up.
Our group uses these flexible LMAs. They can sometimes be a pain to put in because they are so flimsy but they stay out of the surgical field nicely and can be taped down the chin just like an oral RAE
. Ultra Flex Silicon | Reusable LMA
The no IV is interesting for kids. I suppose if the case is really only 10-15 mins, then skipping the IV can really save time. I don’t think it would fly in my hospital because the PACU nurses would make a big deal out of it. We typically don’t even wake any kids up deep because of the PACU staff.
10-15 mins is longer than a typical ear tube that I am used to, which is usually < 5mins... i mean we are giving ODT zofran, IM toraol, Intranasal fentanyl, if im giving all that stuff im just going to put an IV in and give it IV, this sounds like a surgeon-concocted anesthesticHmmm, doesn't sound much different than doing ear tubes - we don't do IVs on those kids, and most of us do it with a mask and not an LMA. Although I guess I'd be at least a little concerned about not having IV access if that oculocardiac reflex decides to show up.
10-15 mins is longer than a typical ear tube that I am used to, which is usually < 5mins... i mean we are giving ODT zofran, IM toraol, Intranasal fentanyl, if im giving all that stuff im just going to put an IV in and give it IV, this sounds like a surgeon-concocted anesthestic
I like the concoction. I assume the OC reflex doesn’t show up because of the local eye drops. Am I correct?It’s not, it’s been concocted over the years by a group of very experienced double and triple boarded pediatric anesthesiologists. It works.
I like the concoction. I assume the OC reflex doesn’t show up because of the local eye drops. Am I correct?
I’m not sure but I haven’t experienced a single instance in hundreds (maybe over 1000) of cases. My theory is that gentle handling of the eye by the surgeon may have something to do with it.
We typically don’t even wake any kids up deep
I have never seen topical neo cause bradycardia. I’m not sure it works that way. When we give it IV the bradycardia comes from the afterload increase.Wouldn’t count on that. The drops won’t keep you out of a trip to Vaso Vegas. In fact all the phenylephrine they dump into the eye can make the propensity for bradycardia worse...
I have never seen topical neo cause bradycardia. I’m not sure it works that way. When we give it IV the bradycardia comes from the afterload increase.