Anaesthesia for paediatric eye surgery

Management of the airway and presentation of a quiescent eye for surgery are key considerations, while control of the oculocardiac reflex and intraocular pressure (IOP) are important both intraoperatively and postoperatively. IOP is affected by almost all aspects of general anaesthesia and should be considered when choosing an anaesthetic technique. Ocular surgery is emetogenic and without prophylaxis is associated with a high incidence of postoperative nausea and vomiting which should be addressed to prevent problematic increase in intraocular pressure. Most procedures are associated with mild to moderate postoperative pain and can usually be managed with simple analgesia. Pain, but also the use of opioid analgesia, is a risk factor for postoperative nausea and vomiting. Examination under anaesthesia, intraocular surgery, correction of squint and emergency ophthalmic surgery each presents its own challenge and all are discussed.