Difference between revisions of "Strabismus surgery"
From WikiAnesthesia
(Created page with "{{Infobox surgical procedure | anesthesia_type =General | airway =LMA | lines_access =1 PIV | monitors =Standard | considerations_preoperative = | considerations_intraoperative = | considerations_postoperative =May need realignment of sutures after emergence }}Provide a brief summary here. ==Overview== ===Indications<!-- List and/or describe the indications for this surgical procedure. -->=== ===Surgical procedure<!-- Briefly describe the major steps of this surg...") |
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type =General | | anesthesia_type = General | ||
| airway =LMA | | airway = LMA | ||
| lines_access =1 PIV | | lines_access = 1 PIV | ||
| monitors =Standard | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = Inhalational vs IV induction | ||
| considerations_intraoperative = | | considerations_intraoperative = Deep anesthetic to prevent laryngospasm with LMA, potential bradycardia from oculocardiac reflex | ||
| considerations_postoperative =May need realignment of sutures after emergence | | considerations_postoperative = May need realignment of sutures after emergence, emergence delirium | ||
}} | }}Strabismus surgery is a common pediatric procedure to prevent the progression of strabismus (cross eyes) to amblyopia (central nervous system vision loss/blindness). | ||
==Overview== | ==Overview== | ||
| Line 48: | Line 48: | ||
|} | |} | ||
===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ||
None | |||
===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ===Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. -->=== | ||
PO Versed 0.5-1 mg/kg | |||
==Intraoperative management== | ==Intraoperative management== | ||
===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->=== | ===Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. -->=== | ||
One PIV is sufficient for this relatively quick procedure with standard monitors. | |||
===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->=== | ===Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. -->=== | ||
Usually an inhalational induction with sevoflurane | |||
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ||
Bed is usually the opthalmology bed with horseshoe-like headrest. Bed will be 90 degrees away. | |||
===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->=== | ===Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. -->=== | ||
* Consider at least 1-1.5 MAC to prevent larygospasm with LMA. A deep anesthetic will also generally blunt triggering of the oculocardiac reflex. | |||
* Consider atropine 20 mcg/kg prior to procedure start or readily drawn up to respond to bradycardia | |||
* Can also consider transitioning to propofol TIVA | |||
* Precedex (see below) | |||
* Good PONV PPX | |||
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ||
* Strabismus patients are notorious for emergence delirium. To mitigate this, deep extubation on propofol can be helpful as well as 0.5 mcg/kg Precedex titrated in small aliquots towards the end of the case | |||
==Postoperative management== | ==Postoperative management== | ||
===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ===Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. -->=== | ||
Same day procedure | |||
===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ===Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. -->=== | ||
Fentanyl is generally sufficient with Tylenol and Toradol +/- Precedex as additional multimodal. | |||
==References== | ==References== | ||
[[Category:Surgical procedures]] | [[Category:Surgical procedures]] | ||
Revision as of 14:54, 4 October 2026
Strabismus surgery
| Anesthesia type |
General |
|---|---|
| Airway |
LMA |
| Lines and access |
1 PIV |
| Monitors |
Standard |
| Primary anesthetic considerations | |
| Preoperative |
Inhalational vs IV induction |
| Intraoperative |
Deep anesthetic to prevent laryngospasm with LMA, potential bradycardia from oculocardiac reflex |
| Postoperative |
May need realignment of sutures after emergence, emergence delirium |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Strabismus surgery is a common pediatric procedure to prevent the progression of strabismus (cross eyes) to amblyopia (central nervous system vision loss/blindness).
Overview
Indications
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
None
Patient preparation and premedication
PO Versed 0.5-1 mg/kg
Intraoperative management
Monitoring and access
One PIV is sufficient for this relatively quick procedure with standard monitors.
Induction and airway management
Usually an inhalational induction with sevoflurane
Positioning
Bed is usually the opthalmology bed with horseshoe-like headrest. Bed will be 90 degrees away.
Maintenance and surgical considerations
- Consider at least 1-1.5 MAC to prevent larygospasm with LMA. A deep anesthetic will also generally blunt triggering of the oculocardiac reflex.
- Consider atropine 20 mcg/kg prior to procedure start or readily drawn up to respond to bradycardia
- Can also consider transitioning to propofol TIVA
- Precedex (see below)
- Good PONV PPX
Emergence
- Strabismus patients are notorious for emergence delirium. To mitigate this, deep extubation on propofol can be helpful as well as 0.5 mcg/kg Precedex titrated in small aliquots towards the end of the case
Postoperative management
Disposition
Same day procedure
Pain management
Fentanyl is generally sufficient with Tylenol and Toradol +/- Precedex as additional multimodal.
References
Top contributors: Tony Wang and BRANDON ETHAN Sumida