Not long ago, a seemingly ordinary eye surgery once again made me re-examine my own anesthesia technique: it was an intraocular foreign body removal. Records in his medical records show that he had been shot through the eye by a steel nail a few months earlier. At that time, the doctor did an urgent treatment for him. However, there was a problem with his lens. According to his description, the lens floats around in his eyeballs and is very influential in life and work.
It's understandable: Who has something floating in their eyes, and who can stand it? What's more, the lens is a very important structure in the eye.
The lens is located in front of the vitreous body, surrounded by a lens suspension ligament connected to the ciliary body, in the shape of a biconvex lens, elastic. The lens is a biconvex transparent tissue that is fixed by a suspensory ligament and suspended in front of the vitreous posterior to the iris. The lens is an important part of the refractive system of the eyeball.
The day before the operation, the ophthalmologist and I said: This eye surgery needs the support of an anesthesiologist. She asked if I could give an intravenous anesthesia.
I was thinking: an eye surgery, what intravenous anesthesia do you want? Besides, your ophthalmology takes up almost all of your face, how do I control the patient's breathing? If respiratory depression occurs, not only is it passive, but the patient is also very dangerous.
But think again: we in the anesthesiology department have a lot of ways. When the time comes, depending on the situation. No, we have a lot of ways to achieve the desired results.
In this way, with full confidence, I took over this job.
However, the situation during the next day's operation scared me into a cold sweat: when the ophthalmologist treated the edges of the lens that stuck to the iris, the patient showed a very sharp pain. And it does hurt to look at that. If we hadn't pressed his hand, he would have almost grabbed the surgical instrument in his face. At that time, he must have known that the surgical area could not be started, and he could hear our drinking, but he still tried to break free, and he could imagine the pain at that time. In that case, it really made me feel very guilty.
Since the patient's face was already covered with a surgical towel, and it was impossible to change the anesthesia to intravenous anesthesia, I decided to give him another safe dose of analgesics. However, the effect is still minimal. No way, the ophthalmologist decided to temporarily change the surgical plan.
Finally after the operation, the ophthalmologist left the operating room with a "success"; the patient knew that we were also for his own good, and said a lot of thank you. I was the only one left, sitting there alone and pondering: Am I wrong?
Back at the office, I quickly checked the information in detail. On the one hand, I have to admit that my knowledge of ophthalmic anatomy is relatively weak; on the other hand, I also want to see how the masters perform anesthesia.
After looking around, I can't help but feel a little lost: because it is intraocular surgery, if you want to completely control the pain, there are only two ways: general anesthesia or post-ball block anesthesia. However, after learning more about post-ball block anesthesia, I retreated.
Retrobulbar block anesthesia is a form of anesthesia that is injected into a muscle cone. The advantage is that it not only makes the eyeball completely anesthetized, the extraocular muscles relax, but also reduces intraocular pressure. Obviously, this is a very suitable form of anesthesia for intraocular surgery.
However, there are several complications of post-ball anesthesia that we cannot accept:
First of all, there is the problem of post-bulbular bleeding. It is mainly caused by post-bulb injections that damage blood vessels. If it is intravenous bleeding, it is fine: the bleeding is relatively slow, and the eyeball is immediately pressed with the palm of the hand. After a while, the surgery can still be continued. Once the arteries bleed, the orbital pressure rises rapidly,
The eyeball is protruding, the eyelids are closed, the surgery must be suspended, the bleeding must be pressed and bandaged. That kind of scene, think about it is very scary. Although it is said that after 2 to 3 days, it is still possible to perform surgery according to the situation, but I am afraid that no one wants such a situation to occur.
Secondly, local anesthetics can appear temporary haze. This kind of hazy can occur immediately or within minutes of injecting local anesthetics. The cause of this may be the direct action of local anesthetics, causing spasms of the central retinal artery or branches of the optic nerve artery. In this case, vasodilation, oxygen inhalation, etc. are given immediately, and most patients can restore visual function. However, it is also a false alarm.
Again, local anesthetics can cause respiratory depression. This one, many people may not understand. The reason for this is that local anesthetics are injected quickly into the peri-optic nerve subdural space and into the pontine and midbrain, so respiratory arrest and loss of consciousness can occur before the circulatory system is affected. This complication, although rare, is urgent. Respiratory management is a top priority for anesthesia. Those who may have breathing problems are classified as unacceptable complications.
All in all, this method of anesthesia is really difficult to accept. Unless you are a very experienced anesthesiologist, you are more confident about performing the anesthesia. And this experience must be based on a large number of similar surgical quantities. If the amount of surgery is small, it must not be tried easily.
At this point, I have summed up a lesson: the next time I encounter such an eye surgery, I must choose general anesthesia, no discussion!
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