A “general”, “local”, or “topical”anesthesia is necessary during all kinds of surgery to reduce or eliminate pain [See figure 1]. Eye surgery is no exception. Topical or local anesthesia, which blocks sensation to one area of the body but does not affect general consciousness, is not appropriate for children having eye surgery but can be considered in adult surgery. General anesthesia, which puts the whole body “to sleep” and eliminates the possibility of movement, is also commonly used, especially for children.
General anesthesia is usually given to adults in two stages. First, a relaxing drug can be given to the patient. This drug is usually delivered through an intravenous (IV) line. An IV line is usually placed in a vein of the arm as part of preparations for surgery. Once in the operating room the additional medicines are administered through the IV line to induce sleep.
After the patient is asleep, a breathing-tube is placed in the windpipe to allow the anesthesiologist to control the patient’s breathing and maintain anesthesia during surgery. Anesthetic agents (inhalation agents) delivered through the tube or medications given intravenously maintain the anesthesia. The breathing tube is removed at the end of surgery before the patient is fully awake. The IV can be removed in the recovery period when the patient is drinking well and has no nausea [See figures 2 and 3].
Anesthetic “sleep” is quite different from normal sleep because the potent medications affect every organ of the body. Achieving and maintaining the desired effect requires continuous monitoring and adjustment. An anesthesiologist has the experience and knowledge to decide which agents are best for the patient and to administer them in a safe manner as possible.
Before surgery, a medical history and physical examination may be performed to be sure the patient is sufficiently healthy for anesthesia. Instructions will be given to stop eating and drinking for a period preceding the surgery. Further instructions about taking any oral prescription medications should also be provided. The staff, nurses, and doctors will try to make the hospital experience a positive one. The patient and any family members should be encouraged to ask questions.
It is important to know if any blood relatives had serious problems with anesthesia such as a high fever (malignant hyperthermia) or not breathing, as some of these problems can be hereditary. Relatives may have had nausea with anesthesia. Nausea is also common after strabismus surgery but medications to ease the discomfort are available.
In general, the patient should not eat food for eight hours or drink anything, even water, for four hours before surgery. The stomach must be empty to avoid possible anesthesia complications. The hospital staff will provide specific instructions about what time the patient stop eating and drinking.
Although strabismus surgery is usually quite routine, the anesthesiologist extensively monitors patients while they are asleep. Serious reactions to anesthesia are extremely rare. All precautions are taken to ensure the patient’s safety while he or she is asleep.
Modern anesthesia techniques also often include special breathing tubes (called laryngeal mask airways) that reduce irritation to the windpipe during surgery and lessen sore throats afterward [See figure 4].
Generally, all family members are asked to wait in a specified area outside the operating area while the patient is taken on a gurney to the operating room. For adults with special needs, some hospitals may have policies permitting family members to be with the patient during the time he or she is going to sleep in the operating room or waking up in the recovery room. Ask the doctor about specific policies at the hospital where the procedure will be performed.
Once the surgery is complete, the tube is removed and normal breathing resumes. The patient is then transferred from the operating room to the recovery room and over the next hour or so gradually wakes up. During this time the patient is often groggy and confused but receives supportive care and reassurance from the recovery room staff who are also monitoring the heart rate, blood pressure, and respiration. During the next few hours the patient will still be sleepy and may have a lowered tolerance for discomfort or pain. Additional reassurance and the use of mild pain medications are helpful when needed. Many adults can be back to normal activities by the next day, although frequently the doctor will advise exercise and work limitations for several days after surgery.
Patients may be nauseated or vomit after eye surgery, particularly muscle surgery. Although the nausea may last for hours, it is rarely serious. Everything possible should be done to provide reassurance and comfort. Medication is sometimes helpful.
Serious anesthesia complications, such as brain damage or death, are exceptionally rare. Generally healthy adults tolerate anesthesia well. Whenever possible, elective eye surgery should be avoided when you are ill. Anesthesiologists and surgeons should be informed of all medical conditions and all medications the patient is taking. They should also be informed of any anesthetic problems the patient or any blood relative has experienced, as there are some rare hereditary conditions, which are associated with a greater risk.
The anesthesiologist monitors with a concentration of inhaled anesthetic vapors to assure that patients will not be aware of pain or other aspects of the surgery.
Some strabismus surgery in teenagers and adults can be done with a local anesthetic injection through the lower eyelid to numb the nerves around the eyeball. Moreover, topical anesthesia may be used in cataract surgery and consists of numbing eye drops to the surface of the eye. However, drops alone do not provide sufficient patient comfort to be used during most other kinds of eye surgery. Hence, local or general anesthesia is used most commonly for eye surgery. If local or topical anesthesia is used, the patient must be still during the procedure to avoid potentially serious complications that may result from sudden unexpected movements. A medication to act as a sedative or to reduce pain may be administered through the IV during surgery as necessary to keep the patient comfortable.
Anesthesia is generally very safe. Complications may be minimized by avoiding food and drink before general anesthesia and postponing elective surgery if the patient is ill. Modern anesthesia allows surgery to be performed without pain or anxiety.
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