Palte Howard D
Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL, USA.
Local Reg Anesth. 2015 Aug 20;8:57-70. doi: 10.2147/LRA.S64806. eCollection 2015.
In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon's block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma.
在过去十年中，眼科麻醉经历了重大变革。在医院环境下全身麻醉下进行眼科手术的时代已经过去。取而代之的是，在专科眼科护理中心，区域麻醉和局部麻醉下进行眼科手术的新曙光已经到来。老年人口不断增加的影响是，越来越多的老年患者将接受眼科手术。为了容纳更多的患者，并同时满足旨在节约成本的管理举措，管理人员将寻求麻醉提供者的帮助，采取提高手术室效率的措施。在等候区进行眼球阻滞符合许多这些目标。不幸的是，大多数执业麻醉医生抵制进行眼科区域阻滞，因为他们缺乏正规培训。未来，麻醉医生将需要进行眼球阻滞并处理常见的医疗状况，因为经济压力将取消常规术前检查。本综述探讨了眼科麻醉中的各种热门问题，特别强调了套管针和基于针头的阻滞以及新一代抗血栓药物。在一个不断发展的领域中，球后阻滞越来越受欢迎，而深部斜角肌锥内（球后）阻滞在很大程度上已被较浅的肌锥外（球周）方法所取代。手术技术的改进也影响了麻醉实践。例如，超声乳化技术有助于在局部麻醉下进行白内障手术，而无缝线玻璃体切除端口在空气/液体交换期间可能导致静脉空气栓塞。透明质酸酶是一种有用的佐剂，因为它促进局部麻醉药的扩散并加快阻滞起效时间，但它具有致敏性。超声引导下的眼球阻滞可实时显示针头位置和局部麻醉药的扩散情况。超声引导的一个优点是，它可以通过识别异常解剖结构（如葡萄肿）来消除眼球穿孔的风险。
