Anesthesia for Ophthalmologic Surgery in the Aged

Ophthalmological surgery is the most common type of surgery performed in geriatric patients. Many of these procedures can be performed on an outpatient basis with local anesthesia. Preparation and management by the anesthesiologist is effective in preventing serious complications. Careful screening is necessary; patients for whom there are contraindications to local anesthesia are given general anesthesia. General anesthesia is required for most long, complicated retinal procedures, even though the patient may be quite ill; diabetes mellitus with all its complications is a particular problem. Some patients requiring eye surgery need to be admitted to the hospital for care and treatment to insure optimal conditions before surgery.

Many elderly patients suffer from misconceptions; they are very anxious about the possibility of losing vision. Careful preparation and judicious use of premedicant drugs are required. Drug interactions must be avoided and necessary cardiac and antihypertensive drugs continued perioperatively. Because geriatric patients are very susceptible to drug effects, careful titration is necessary, with avoidance of drugs with long half-lives.

During surgery, life-threatening complications of retrobulbar blocks may occur. Prompt, effective treatment is mandatory. There must be constant vigilance regarding vagal reflexes and interactions of ophthalmic drugs.

Patients with eye perforations need very smooth general anesthesia with avoidance of coughing or bucking to avoid further extrusion of eye contents. Nondepolarizing muscle relaxants should be chosen with avoidance of succinylcholine. In cases of suspected difficult intubations, the patient's life should not be placed in severe jeopardy to try to save his eye.

Patients with endophthalmitis are emergent; prompt recognition and aggressive therapy are necessary if there is to be a chance of maintaining useful vision.

Consummate skill of the anesthesiologist, knowledge of surgical techniques and special requirements of the surgeon, with special patient preparation are necessary for optimal anesthetic care of elderly ophthalmologic patients.