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Ophthalmic surgery

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Abstract

Patients with ophthalmic disease may require surgery to correct adnexal disease such as entropion, corneal disease, intraocular disease such as cataract, or to remove the globe (enucleation). Patients vary from young, healthy animals with ocular injury or congenital disease to geriatric patients, which may have significant comorbidities. This chapter looks at factors to consider when planning anaesthesia for an ophthalmic patient, ocular physiology relevant to anaesthesia, ocular pain and systemic effects of ophthalmic drugs.

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Figures

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19.6 Diagram of a cross-section of the canine cornea, the sensory nerve supply and how it affects the degree of pain associated with superficial and deep corneal ulcers. The deep stroma of the cornea contains pressure receptors which respond to increased intraocular pressure in acute glaucoma. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission.
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19.1 A young Pug with a deep corneal ulcer. The eye is painful and there is a risk of globe rupture if the intraocular pressure were to increase suddenly. The animal has a significant comorbidity (brachycephalic obstructive airway syndrome) and surgery is likely to require a centrally positioned cornea (achieved by the use of a neuromuscular blocking agent). (Courtesy of the AHT Comparative Ophthalmology Unit, Newmarket, UK)
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19.3 Management- and anaesthesia-related factors causing increased intraocular pressure. CVP = central venous pressure; IPPV = intermittent positive pressure ventilation; PCO = arterial carbon dioxide tension; PO = arterial oxygen tension. (© Juliane Deubner, University of Saskatchewan, Canada)
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19.4 Sensory innervation of the eye. (© Juliane Deubner, University of Saskatchewan, Canada)
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19.9 A retrobulbar needle.
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19.10 The inferior temporal palpebral technique for retrobulbar injection. (a) Anatomical landmarks. (b) Needle positioning.
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19.11 Diagrams illustrating the inferior temporal palpebral technique for retrobulbar injection. (a) Lateral view. (b) Dorsal view. (© Juliane Deubner, University of Saskatchewan, Canada)
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19.12 Typical layout of an ophthalmology operating theatre, showing limited patient access for the anaesthetist. (Courtesy of Elvira Peeters, Animal Health Trust, Newmarket, UK)
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19.13 Medial saphenous vein of a cat. (Courtesy of Emma Archer, Animal Health Trust, Newmarket, UK)
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19.14 Ophthalmic patient positioned in dorsal recumbency with the neck flexed. A right-angled connector is being used to improve surgical access to the eye and reduce drag on the endotracheal tube.
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19.15 A central eye. The cornea is positioned centrally within the palpebral fissure following the administration of a neuromuscular blocking agent. (Courtesy of Fiona Scarlett, Animal Health Trust, Newmarket, UK)
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19.16 Electrodes for a peripheral nerve stimulator positioned over the peroneal nerve. An intravenous catheter has been placed in the lateral saphenous vein and the area clipped over the medial saphenous vein for blood sampling, enabling easy access for the anaesthetist.
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19.18 Blanching of (a) the tongue and (b) oral mucous membranes following ocular administration of phenylephrine drops. (b, Courtesy of Fiona Scarlett, Animal Health Trust, Newmarket, UK)

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