Abstract
Eye and ear procedures constitute a significant proportion of all surgeries performed worldwide. Most are accomplished on an outpatient basis, with more extensive and complex procedures conducted in a hospital setting. Anesthesia for eye surgery may be challenging because patients are often at extremes of age, either very young or very elderly. The latter brings a host of medical comorbidities commonly associated with advanced age, whereas neonates and children often have associated systemic syndromes that require comprehensive evaluation and care. For adults, most ophthalmic operations are performed with monitored anesthesia care and some form of regional or topical eye anesthetic. Therefore knowledge of regional ophthalmic block techniques and management of their complications is essential. For all ophthalmology surgery patients, the anesthesia provider must understand the physiology of intraocular pressure (IOP) and the oculocardiac reflex, the influence of both ophthalmic medications and anesthesia agents and the ramifications of specific ophthalmologic disease states and anesthesia issues associated with the surgical procedures performed to correct those pathologies.
For ear, nose, and throat surgery, anesthetic considerations include anatomic airway aberrations, airway irritability, and limited access to the head during surgery. Laser treatment in the airway carries risk for fire and thus necessitates use of appropriate equipment and prophylactic antiignition measures. Children undergoing tonsillectomy often have obstructive sleep apnea and are at risk for postoperative hypoxemia. They may experience postoperative bleeding that can be a surgical emergency with profound anesthesia implications. For ear surgery, the use of neuromuscular blocking agents is generally curtailed to facilitate ongoing assessment of facial nerve function, as a branch of this cranial nerve courses through the middle ear.