AANA Journal course: update for nurse anesthetists--anesthesia for the ruptured globe

Anesthesia for the patient with a perforated globe can be complicated. Cognizance of the anatomy and physiology of the eye, including maintenance of intraocular pressure, is essential for the development of an anesthetic plan. Since the induction phase of anesthesia is the most critical period during which intraocular pressure is affected, understanding the pharmacology of the various anesthetic agents and their effects on the eye is important. To avoid increasing intraocular pressure, a smooth, atraumatic induction is desired. However, methods to achieve this end may place the patient at risk for aspiration. Various techniques that attempt to accomplish this goal are described, including the use of narcotics, lidocaine, nitroglycerin, alpha (alpha 2) agonism, beta (beta) adrenergic and calcium channel blockades, plus the laryngeal mask airway.