Strabismus surgery

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
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Strabismus surgery is a common pediatric procedure to prevent the progression of strabismus (cross eyes) to amblyopia (central nervous system vision loss/blindness).

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.