A review of current ophthalmic anaesthetic practice

Abstract

Intro: Ophthalmic surgery ranks among the commonest procedures performed worldwide. This review considers the range of anaesthetic techniques available to the modern ophthalmic anaesthetist, and practical considerations to evaluate in different circumstances. There is a brief summary of the main issues pertaining to the common ophthalmic subspecialties and operations.

Sources of data: Pubmed.

Areas of agreement: We present a view of contemporary ophthalmic anaesthetic practice as we see it, both from current UK clinical experience, and the available published evidence.

Areas of controversy: There is an ongoing debate about the safety of sharp needle blocks (SNBs) compared to subtenons and topical techniques, but SNBs still have a role to play, both in specific cases, and in circumstances where resources are limited.

Growing points: It remains a challenge to provide safe, cost effective anaesthesia to a growing patient base with ever increasing demands and medical comorbidities. There is a continuing trend towards replacing general with local anaesthesia where possible.

Research: Research in ophthalmic anaesthesia, as in so many areas, has been plagued by heterogeneity and small studies. A coordinated, large scale, multicentred approach to research questions in future would help to guide best practice with more certainty.

Keywords: general anaesthesia for ophthalmic surgery; ophthalmic anaesthesia; peribulbar anaesthesia; regional anaesthesia; sub-Tenon’s.