1. Paediatric penetrating eye injuries
WARM ANAESTHESIA GREETINGS
Dr . S.PARTHASARATHY
MD., DA., DNB

2. Normal IOP IOP = 12 – 20 mm Hg. 4 P and IOP ↑ systolic BP
↑ venous pressure
Direct pressure
Sympathetic stimulation
↑ IOP

3. Full stomach and smooth induction.
Routine preop check up.
Evidence of other injuries.
NPO status.
Routine investigations.

4. Premed Oral sedatives ok Inj. PPI s or H2 Blockers IV
IM better avoided – crying ↑ IOP.
EMLA for IV access.
Anti emetic and narcotic IV before induction.

5. Induction Rapid sequence induction with thio and suxa ??
Suxa increase IOP
Benefits Vs risks.
Propofol, NDPs and better to monitor NMJ and intubate.

6. No coughing or bucking
for blunting intubation response
IV lignocaine 1.5 mg/kg
Clonidine 75mic.gm
Beta blocker labetolol 0.03mg/kg

7. Mask holding careful.
Injure eyes
No airway obstruction
Obstructed breathing ↑ IOP
No ketamine
Be careful about OCR

8. Intubate for full stomach patients
LMA with smooth in and out is other wise good.
Armoured tube if surgeon requests.
15* head up tilt
Normal PaCo2
Normal BP.

9. Extubation smooth
Narcotic and antiemetic before
IV lignocaine SOS.
Anxiety, airway obstruction, restlessness, full bladder, retching are all dangerous.

10. Thank you all