Prevalent Attitudes Regarding Residency Training in Ocular Anesthesia

Miller-Meeks, Mariannette J.; Bergstrom, Terry J.; Karp, Kenneth O

doi:10.1016/s0161-6420(94)31162-6

Cited by 18 publications

(6 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unfortunately, fewer than 25% of anesthesiology residency programs provide hands-on clinical instruction in ophthalmic regional anesthesia. 2 Anesthesiologists avoid performing eye blocks because of the perceived risk of globe perforation, muscle damage, and optic nerve injury. This misperception has been propagated by two 1990s publications that documented multiple cases of globe penetration following blocks performed by anesthesiologists.…”

Section: Trainingmentioning

confidence: 99%

Ophthalmic regional blocks: management, challenges, and solutions

Palte¹

2015

LRA

View full text Add to dashboard Cite

In the past decade ophthalmic anesthesia has witnessed a major transformation. The sun has set on the landscape of ophthalmic procedures performed under general anesthesia at in-hospital settings. In its place a new dawn has ushered in the panorama of eye surgeries conducted under regional and topical anesthesia at specialty eye care centers. The impact of the burgeoning geriatric population is that an increasing number of elderly patients will present for eye surgery. In order to accommodate increased patient volumes and simultaneously satisfy administrative initiatives directed at economic frugality, administrators will seek assistance from anesthesia providers in adopting measures that enhance operating room efficiency. The performance of eye blocks in a holding suite meets many of these objectives. Unfortunately, most practicing anesthesiologists resist performing ophthalmic regional blocks because they lack formal training. In future, anesthesiologists will need to block eyes and manage common medical conditions because economic pressures will eliminate routine preoperative testing. This review addresses a variety of topical issues in ophthalmic anesthesia with special emphasis on cannula and needle-based blocks and the new-generation antithrombotic agents. In a constantly evolving arena, the sub-Tenon’s block has gained popularity while the deep angulated intraconal (retrobulbar) block has been largely superseded by the shallower extraconal (peribulbar) approach. Improvements in surgical technique have also impacted anesthetic practice. For example, phacoemulsification techniques facilitate the conduct of cataract surgery under topical anesthesia, and suture-free vitrectomy ports may cause venous air embolism during air/fluid exchange. Hyaluronidase is a useful adjuvant because it promotes local anesthetic diffusion and hastens block onset time but it is allergenic. Ultrasound-guided eye blocks afford real-time visualization of needle position and local anesthetic spread. An advantage of sonic guidance is that it may eliminate the hazard of globe perforation by identifying abnormal anatomy, such as staphyloma.

show abstract

Section: Trainingmentioning

confidence: 99%

Ophthalmic regional blocks: management, challenges, and solutions

Palte¹

2015

LRA

View full text Add to dashboard Cite

show abstract

“…The Bonica et al 12 article does focus on epidural epinephrine, but given that the translocation of drugs from the epidural space to the systemic circulation is rapid, it is reasonable to use this pharmacokinetic model as a point of maximum reference relative to clearance of drug from peripheral locations. The Bonica et al 12 article does focus on epidural epinephrine, but given that the translocation of drugs from the epidural space to the systemic circulation is rapid, it is reasonable to use this pharmacokinetic model as a point of maximum reference relative to clearance of drug from peripheral locations.…”

Section: Mechanisms Of Hypotension and Bradycardia During Regional Anmentioning

confidence: 99%

“…6 Although peribulbar anesthesia affords greater safety, the possibility of scleral perforation, hemorrhage, brainstem anesthesia, and dysrhythmia still exist. 12 We strongly advocate that before performing any method of ocular anesthesia, attending anesthesiologists obtain adequate training/education through a suitable university program or via an organization such as the Ophthalmic Anesthesia Society. The author details in his article that all of these complications have been reported with STB anesthesia.…”

Section: Sub-tenon Techniques Should Be One Option Among Manymentioning

confidence: 99%

Combination of Morphine with Ketamine for Patient-controlled Analgesia: Is Ketamine Plasma Concentration Adequate?

Elstraete¹,

Delanoue

Fuzier

2004

Anesthesiology

View full text Add to dashboard Cite

We read with interest the recent report by Martinez et al. 1 regarding a combined infraclavicular plexus blockade with suprascapular nerve block for humeral head surgery in a patient with severe respiratory failure. However, we have some concerns with regard to the following points: First, it is not clearly stated whether the authors performed an infraclavicular plexus block using the coracoid technique (originally described by Whiffler 2 ) or the vertical infraclavicular technique (described by Kilka et al. 3 ). In the case report section the authors wrote, "brachial plexus was performed using "the coracoid and infraclavicular technique." However, figure 1B in the case report of Martinez et al. shows the territories usually blocked by the vertical infraclavicular brachial plexus block. One must be aware of the different extensions of sensory blockade produced by the coracoid technique, the vertical infraclavicular technique, and the modified approach of the Raj technique. 4 Because the coracoid technique approaches the brachial plexus more distally than the vertical infraclavicular technique, the axillary and musculocutaneus nerves are often missed or are not adequately blocked with the former technique. Deleuze et al. 5 described a successful sensory blockade of the axillary nerve by the coracoid technique in only about 22%. Gaertner et al. 6 showed that a multiple injection technique, as compared to a single injection, improved the overall success rate of the coracoid technique from 40% up to more than 70%, without detailing the effect on the axillary nerve.Martinez performed a suprascapular nerve block to avoid hemidiaphragmatic paresis secondary to interscalene brachial plexus block. In the current case, the possibility of an iatrogenic pneumothorax during this procedure must be mentioned. 7 This theoretical disadvantage is also described for the vertical infraclavicular technique. 8 In the current case, a pneumothorax could have been at least as deleterious as a phrenic nerve paresis. As shown by Borgeat et al. 9 and Boezaart et al., 10 the decrease of hemidiaphragmatic excursion after interscalene brachial plexus block can be reduced when the block is performed through the interscalene catheter rather than with a single bolus. The catheter technique, either performed at the interscalene or at the infraclavicular level (where the modified approach of the Raj technique seems to be the optimal solution 11 ), would have also offered good surgical conditions and efficient postoperative analgesia without the danger of a pneumothorax or an insufficient block.

show abstract

“…First, few ophthalmology programs offer formal training to anesthesiology residents in ocular anesthesia. 1 Second, anesthesia trainees are afforded limited opportunity to acquire skills in ophthalmic regional anesthesia because eye surgical cases are often referred in few specialized institutions. Moreover, peribulbar or sub-Tenon anesthesia may be incorrectly perceived as techniques that can rapidly be mastered by residents and do not require proper teaching methods.…”

mentioning

confidence: 99%