Open Eye–Full Stomach. Anesthesiologists must balance the risk of aspiration against the risk of blindness in an injured eye that could result from an acute increase in IOP and extrusion of ocular contents.
Rocuronium (1.2 mg/kg IV) may be useful for rapid control of the airway, but its intermediate duration of action is a disadvantage compared with Sch. Sugammadex may provide a solution.
When confronted with a patient whose airway anatomy or anesthetic history suggests potential difficulties, the anesthesiologist should consult with the ophthalmologist concerning the probability of saving the injured eye.
Internal tamponade of the retinal break may be accomplished by injecting the expandable gas SF6 into the vitreous. Owing to the blood/gas partition coefficient differences, the concomitant administration of N2O may enhance the internal tamponade effect of SF6 intraoperatively, resulting in increases in IOP and interference with retinal circulation. For this reason, N2O probably should be discontinued for at least 15 minutes before injection of SF6, and likewise N2O probably should not be administered for 10 days after the injection.
A decrease in IOP is often provided by IV administration of acetazolamide or mannitol.
Akinesia is not critical, and inhalation anesthetics need not be accompanied intraoperatively by nondepolarizing muscle relaxants.