[What's new in ophthalmic anaesthesia?]

Area of Science:

• Anesthesiology
• Ophthalmology

Context:

• Recent advancements in ophthalmic anesthesia have introduced safer general and regional anesthesia techniques.
• Ophthalmic surgery patients are often elderly with comorbidities (ASA III-IV), increasing anesthetic risks.
• Life-threatening cardiovascular events and the need for interventions like hypertension and dysrhythmia management are common.

Purpose:

• To review current changes and considerations in ophthalmic anesthesia.
• To highlight the impact of anesthetic drugs on intraocular pressure (IOP) and pulsatile ocular blood flow (POBF).
• To discuss risk management strategies for patients on anticoagulants/antiplatelet agents and the prevention of postoperative nausea and vomiting (PONV).

Summary:

• General anesthesia offers controllability and efficient OR management, while regional anesthesia, particularly topical, is increasingly used for cataract surgery.
• Anesthetic choices impact IOP and POBF; specific drugs like remifentanil and the use of laryngeal masks can mitigate risks.
• Managing patients on anticoagulants requires balancing bleeding risks with thrombotic events. PONV prevention involves avoiding long-acting opioids and using antiemetics.

Impact:

• Improved patient safety and OR efficiency through optimized anesthetic management.
• Enhanced understanding of how anesthetic agents affect ocular hemodynamics, guiding clinical decisions.
• Strategies to reduce perioperative risks and postoperative complications like PONV in ophthalmic surgery patients.