A “general” or “local” anesthesia is necessary during all kinds of surgery to reduce or eliminate pain. Eye surgery is no exception. Local anesthesia, which blocks sensation to one area of the body but does not affect general consciousness, is rarely appropriate for children having eye surgery. General anesthesia, which puts the whole body “to sleep” and eliminates the possibility of movement, is commonly used. Occasionally, general anesthesia may be required to perform a complete eye examination on a child, even if no invasive surgery is planned [See figures 1 and 2].
General anesthesia is usually given to children in two stages. First, a relaxing drug is given which causes the child to drift off to sleep. This drug is usually delivered as a gas through a scented face mask. An intravenous (IV) line is usually placed in a vein of the arm or leg after a young child is asleep from the mask. Older children may have the IV line placed before going to sleep.
After the child is asleep, a mask may be held over the child’s mouth and nose for a brief procedure (such as opening blocked tear ducts). For most eye procedures, however, a breathing-tube is placed in the windpipe to allow the anesthesiologist to control the child’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 child is fully awake. The IV can be removed in the recovery period when the child is drinking well and has no nausea.
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. Your anesthesiologist has the experience and knowledge to decide which agents are best for your child and to administer them in a safe manner as possible.
Parents should tell children old enough to understand why they are having surgery. Your hospital may provide tours to show its facilities and explain its procedures to the child. Most children are inquisitive and are fascinated by all the machines in the operating room. They should be encouraged to ask questions. The staff, nurses, and doctors will try to make the hospital experience a positive one [See figure 3].
Before surgery, a medical history and physical examination may be performed to be sure your child is sufficiently healthy for anesthesia.
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, your child should not eat food or drink baby formula for eight hours or drink anything, even water or breast milk, for four hours before surgery. The stomach must be empty to avoid possible anesthesia complications. The hospital staff will give you specific instructions about what time your child must stop eating and drinking.
Many hospitals will give a liquid sedative to children prior to surgery to help ease any apprehension. A sedative comforts children as they await their surgery, reduces anxiety as they move into the operating room, and helps them forget the events immediately associated with their surgery.
Although strabismus surgery is usually quite routine, children are extensively monitored by the anesthesiologist while they are asleep. Serious reactions to anesthesia are extremely rare. All precautions are taken to ensure children’s safety while they are 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].
Each hospital will have its own policies about parents being with the child during the time the child is going to sleep in the operating room or waking up in the recovery room. Ask your doctor about specific policies at your hospital.
Once the surgery is complete, the tube is removed and normal breathing resumes. The child is then transferred from the operating room to the recovery room and over the next hour or so gradually wakes up. During this time children are often groggy and confused but receive supportive care and reassurance from the recovery room staff who are also monitoring the child’s heart rate, blood pressure, and respiration. During the next few hours the child will still be sleepy, sometimes cranky, and may have a lowered tolerance for discomfort or pain. Additional reassurance and the use of mild pain medications are helpful when needed. Most children are back to many normal activities by the next day. Occasionally a child will sleep for hours, especially after a long surgical procedure or if sedating pain medications are required.
Children 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 reassure the child and make him or her comfortable. Medication is sometimes helpful.
Serious anesthesia complications, such as brain damage or death, are exceptionally rare. Generally healthy children tolerate anesthesia at least as well as adults.
Whenever possible, elective eye surgery should be avoided when the child is ill. Anesthesiologists and surgeons should be informed of all medical conditions and all medications the child is taking. They should also be informed of any anesthetic problems the child or any blood relative has experienced, as there are some rare hereditary conditions, which are associated with a greater risk.
The anesthesiologist monitors with concentration of inhaled anesthetic vapors to assure that your child will not be aware of pain or other aspects of the surgery.
Generally, No. 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. Unlike its use in adult cataract surgery, topical anesthesia, consisting of numbing eye drops to the surface of the eye, may not provide sufficient patient comfort to be used during eye muscle surgery. Strabismus surgery typically requires 30 minutes and often significantly longer to complete. The patient must be still and comfortable during this period to avoid potentially serious complications that may result from sudden unexpected movements. As most children cannot be expected remain still for the time necessary to complete the surgery, nearly all children require general anesthesia in order for eye muscle surgery to be performed safely and comfortably.
Anesthesia for children is generally safe. Complications may be minimized by avoiding food and drink before general anesthesia and postponing elective surgery if the child is ill. Modern anesthesia allows surgery or examinations to be performed without pain or anxiety.
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