Publications by authors named "Steven Gayer"

44 Publications

Venous Air Embolus: A Rare but Serious Complication of Fluid-Gas Exchange during Pars Plana Vitrectomy.

Am J Ophthalmol 2021 Mar 24. Epub 2021 Mar 24.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address:

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http://dx.doi.org/10.1016/j.ajo.2021.03.018DOI Listing
March 2021

Electroretinogram Recording for Infants and Children under Anesthesia to Achieve Optimal Dark Adaptation and International Standards.

J Vis Exp 2020 09 3(163). Epub 2020 Sep 3.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.

Electroretinogram (ERG) is the only clinical objective test available to assess retinal function. Full-field ERG (ffERG) measures the panretinal rod and cone photoreceptor function as well as inner retinal function and is an important measure in the diagnosis and management of inherited retinal diseases as well as inflammatory, toxic, and nutritional retinopathies. Adhering to international standards and maintaining retinal dark adaptation are critical to acquire valid and reliable dark-adapted (scotopic) and light-adapted (photopic) ffERG responses. Performing ffERG in infants and children is challenging and often requires general anesthesia in the operating room. However, maintaining retinal dark adaptation in the operating room is becoming increasingly difficult given the numerous light sources from anesthesiology monitoring systems and other equipment. A practical and widely applicable method for ffERG testing is described in the operating room that optimizes retinal dark adaptation. The method reduces operating room time by dark-adapting the patient before general anesthesiology is instituted. The operating room is modified for dark adaptation and any remaining light source in the darkened operating room is minimized with the use of a modified portable foldable darkroom that encloses the patient's head and the ERG examiner during ffERG scotopic recordings. The simple method adheres to ffERG international standards and provides valid reliable scotopic and photopic ffERG recordings that are critical to assess objective retinal function in this young age group where subjective assessment of visual function such as visual acuity and visual fields are not possible. Furthermore, the ffERG is the gold standard clinical test in detecting early onset inherited retinal diseases including Leber congenital amaurosis where approved gene therapy has become available. In sedated conditions, very low amplitude ffERG signals can be detected due to minimal orbicularis muscle activity interference, which is particularly relevant in patients after gene therapy to detect improved amplitude responses.
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http://dx.doi.org/10.3791/61734DOI Listing
September 2020

Safe and sound.

Reg Anesth Pain Med 2020 Sep 18. Epub 2020 Sep 18.

Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA.

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http://dx.doi.org/10.1136/rapm-2020-101961DOI Listing
September 2020

In Response.

Anesth Analg 2019 12;129(6):e202

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts Department of Anesthesiology and Perioperative Medicine, Penn State Hershey Medical Center/Penn State Health, Hershey, Pennsylvania Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Health System, Miami, Florida Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas,

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http://dx.doi.org/10.1213/ANE.0000000000004449DOI Listing
December 2019

Succinylcholine Use and Dantrolene Availability: Comment.

Anesthesiology 2019 10;131(4):934

University of Texas Southwestern Medical School, Dallas, Texas (G.P.J.).

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http://dx.doi.org/10.1097/ALN.0000000000002949DOI Listing
October 2019

Current Trends in Vitreoretinal Anesthesia.

Ophthalmol Retina 2019 09 29;3(9):804-805. Epub 2019 May 29.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida. Electronic address:

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http://dx.doi.org/10.1016/j.oret.2019.05.020DOI Listing
September 2019

Malignant Hyperthermia-Susceptible Adult Patient and Ambulatory Surgery Center: Society for Ambulatory Anesthesia and Ambulatory Surgical Care Committee of the American Society of Anesthesiologists Position Statement.

Anesth Analg 2019 08;129(2):347-349

Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas.

This document represents a joint effort of the Society for Ambulatory Anesthesia (SAMBA) and the Ambulatory Surgical Care Committee of the American Society of Anesthesiologists (ASA) concerning the safe anesthetic care of adult malignant hyperthermia (MH)-susceptible patients in a free-standing ambulatory surgery center (ASC). Adult MH-susceptible patients can safely undergo a procedure in a free-standing ASC assuming that proper precautions for preventing, identifying, and managing MH are taken. The administration of preoperative prophylaxis with dantrolene is not indicated in MH-susceptible patients scheduled for elective surgery. There is no evidence to recommend an extended stay in the ASC, and the patient may be discharged when the usual discharge criteria for outpatient surgery are met. Survival from an MH crisis in an ASC setting requires early recognition, prompt treatment, and timely transfer to a center with critical care capabilities.
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http://dx.doi.org/10.1213/ANE.0000000000004257DOI Listing
August 2019

Cataract Surgery: When the Eyes Are Bigger Than the Stomach.

Anesth Analg 2019 04;128(4):e58

Department Anesthesiology, University of Miami, Miller School of Medicine, Miami, Florida,

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http://dx.doi.org/10.1213/ANE.0000000000004054DOI Listing
April 2019

Regional Anesthesia for Pediatric Ophthalmic Surgery: A Review of the Literature.

Anesth Analg 2020 05;130(5):1351-1363

Department of Anesthesiology, Perioperative Medicine and Pain Management, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami Health System, Miami, Florida.

Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction anesthesia in pediatric ophthalmic surgery. Key anatomic differences in axial length, intraocular pressure, and available orbital space between young children and adults impact conduct of ophthalmic regional anesthesia. The eye is near adult size at birth and completes its growth rapidly while the orbit does not. This results in significantly diminished extraocular orbital volumes for local anesthetic deposition. Needle-based blocks are categorized by relation of the needle to the extraocular muscle cone (ie, intraconal or extraconal) and in the cannula-based block, by description of the potential space deep to the Tenon capsule. In children, blocks are placed after induction of anesthesia by a pediatric anesthesiologist or ophthalmologist, via anatomic landmarks or under ultrasonography. Ocular conduction anesthesia confers several advantages for eye surgery including analgesia, akinesia, ablation of the oculocardiac reflex, and reduction of postoperative nausea and vomiting. Short (16 mm), blunt-tip needles are preferred because of altered globe-to-orbit ratios in children. Soft-tip cannulae of varying length have been demonstrated as safe in sub-Tenon blockade. Ultrasound technology facilitates direct, real-time visualization of needle position and local anesthetic spread and reduces inadvertent intraconal needle placement. The developing eye is vulnerable to thermal and mechanical insults, so ocular-rated transducers are mandated. The adjuvant hyaluronidase improves ocular akinesia, decreases local anesthetic dosage requirements, and improves initial block success; meanwhile, dexmedetomidine increases local anesthetic potency and prolongs duration of analgesia without an increase in adverse events. Intraconal blockade is a relative contraindication in neonates and infants, retinoblastoma surgery, and in the presence of posterior staphylomas and buphthalmos. Specific considerations include pertinent pediatric ophthalmologic topics, block placement in the syndromic child, and potential adverse effects associated with each technique. Recommendations based on our experience at a busy academic ophthalmologic tertiary referral center are provided.
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http://dx.doi.org/10.1213/ANE.0000000000004012DOI Listing
May 2020

Novel technique for minimally invasive sub-Tenon's anesthesia.

Reg Anesth Pain Med 2019 01;44(1):131-132

Department of Anesthesiology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA.

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http://dx.doi.org/10.1136/rapm-2018-000025DOI Listing
January 2019

The Eye: What You Don't Know Can Hurt Your Patient.

Anesth Analg 2018 05;126(5):1446-1447

Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota.

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http://dx.doi.org/10.1213/ANE.0000000000002846DOI Listing
May 2018

Pediatric Eye Blocks: Threading the Needle.

Reg Anesth Pain Med 2018 01;43(1):103

Bascom Palmer Eye Institute and Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL; Bascom Palmer Eye Institute and Departments of Ophthalmology and Anesthesiology Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, FL.

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http://dx.doi.org/10.1097/AAP.0000000000000697DOI Listing
January 2018

Comparison of Regional vs. General Anesthesia for Surgical Repair of Open-Globe Injuries at a University Referral Center.

Ophthalmol Retina 2017 May-Jun;1(3):188-191. Epub 2017 Jan 19.

Department of Anesthesiology, University of Miami, Miller School of Medicine, 1611 NW 12th Ave, Miami, FL 33136.

Purpose: This study compares the clinical features and physician selection of either Regional Anesthesia (peribulbar or retrobulbar block) with Monitored Anesthesia Care (RA-MAC) or General Anesthesia (GA) for open globe injury repair.

Design: A non-randomized, comparative, retrospective case series at a University Referral Center.

Participants: All adult repairable open globe injuries receiving primary repair between January 1st, 2004 and December 31st, 2014 (11 years). Exclusion criteria were patients less than 18 years of age and those treated with primary enucleation.

Methods: Data was gathered via retrospective chart review.

Main Outcome Measures: Data collected from each patient was age, gender, injury type, location, length of wound, presenting visual acuity, classification of anesthesia used, duration of the procedure performed, months of clinical follow-up, and final visual acuity.

Results: During the 11 years study period, 448 patients were identified who had open globe injuries with documented information on zone of injury. Globe injury repair was performed using RA-MAC in 351/448 (78%) patients and general anesthesia in 97/448 (22%) patients. Zone 1, 2 and 3 injuries were recorded in 241, 135, and 72 patients respectively. The rates in specific zones, of RA-MAC versus GA were as follows: Zone 1 - 213/241 (88%) vs 28/241 (12%), Zone 2 - 104/135 (77%) vs 31/135 (23%) and Zone 3 - 34/72 (47%) vs 38/72 (53%). Open globe injuries repaired under RA-MAC had significantly shorter wound length (p<0.001), more anterior wound location (p<0.001) and shorter operative times (p<0.001). RA-MAC cases also had a better presenting and final visual acuity (p<0.001). Neither class of anesthesia conferred a greater visual acuity improvement (p=0.06). The use of GA did not cause any delay in the time elapsed from injury until surgical repair (p=0.74).

Conclusions: RA-MAC is a reasonable alternative to GA for the repair of open globe injuries in selected adult patients. RA-MAC was selected more often for Zone 1 and Zone 2 injuries. For eyes with Zone 3 injuries, there are equal selection ratio for RA-MAC and GA.
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http://dx.doi.org/10.1016/j.oret.2016.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607023PMC
January 2017

Succinylcholine for Emergency Airway Rescue in Class B Ambulatory Facilities: The Society for Ambulatory Anesthesia Position Statement.

Anesth Analg 2017 05;124(5):1447-1449

From the *Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas; †Nova Anesthesia, Villanova, Pennsylvania; ‡Department of Anesthesiology, University of Miami, Miami, Florida; §Pediatric Dental Anesthesiology Associates, Tampa, Florida.

Procedures in class B ambulatory facilities are performed exclusively with oral or IV sedative-hypnotics and/or analgesics. These facilities typically do not stock dantrolene because no known triggers of malignant hyperthermia (ie, inhaled anesthetics and succinylcholine) are available. This article argues that, in the absence of succinylcholine, the morbidity and mortality from laryngospasm can be significant, indeed, higher than the unlikely scenario of succinylcholine-triggered malignant hyperthermia. The Society for Ambulatory Anesthesia (SAMBA) position statement for the use of succinylcholine for emergency airway management is presented.
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http://dx.doi.org/10.1213/ANE.0000000000001682DOI Listing
May 2017

Ultrasound-guided ophthalmic regional anesthesia.

Curr Opin Anaesthesiol 2016 Dec;29(6):655-661

aDepartment of Anesthesiology bDepartment of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.

Purpose Of Review: Needle-based and cannula-based eye blocks are 'blind' techniques prone to rare but serious complications. Ultrasound, an established adjunct for peripheral nerve block, may be beneficial for ophthalmic anesthesia application. The present review details the evolution of ultrasound-guided eye blocks, outlines safety issues, and reviews recent studies and editorial opinions.

Recent Findings: Ultrasound-assisted ophthalmic regional anesthesia allows imaging of key structures such as the globe, orbit, and optic nerve. Recent findings reveal that needle path is not reliably predictable by clinical evaluation. Needle tips are frequently found to be intraconal, extraconal, or transfixed in the muscle cone independent of the intended type of block. In addition, contemporary human and animal studies confirm that real-time observation of local anesthetic spread inside of the muscle cone correlates directly with block success.

Summary: Ultrasound-guided ophthalmic regional anesthesia is evolving beyond simple visualization of the anatomy. Recent research emphasizes the imprecision of needle tip location without ultrasound and the key role of imaging local anesthetic dispersion. There is ongoing debate in the literature regarding the utility of routine ultrasound for eye blocks.
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http://dx.doi.org/10.1097/ACO.0000000000000393DOI Listing
December 2016

In Vivo Porcine Model of Venous Air Embolism During Pars Plana Vitrectomy.

Am J Ophthalmol 2016 Nov 25;171:139-144. Epub 2016 Jun 25.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.

Purpose: Venous air embolism (VAE) during pars plana vitrectomy (PPV) can occur owing to improper positioning of the infusion cannula in the suprachoroidal space and may lead to sudden compromise of cardiac circulation and death. This was an in vivo demonstration of fatal VAE during PPV to show that air can travel from the suprachoroidal space into the central circulation.

Design: Experimental in vivo surgical study on porcine eyes.

Methods: Experimental PPV under general anesthesia was performed on porcine eyes (Yorkshire species) at a University Surgical Training & Education Center. Infusion cannulas were placed into the suprachoroidal space and fluid-air exchange (FAE) was started with sequential increases in infusion air pressure. Vital signs of porcine animals were continuously monitored and recorded in real time during the PPV, including end-tidal carbon dioxide (ETCO), oxygen saturation (SaO), intra-arterial blood pressure, electrocardiography (EKG), and transesophageal echocardiography (TEE).

Results: Intracardiac air was detected on TEE less than 30 seconds after increasing air infusion pressure to 60 mm Hg. ETCO declined precipitously, followed by hypotension and EKG changes. Oxygen desaturation was a late phenomenon. The animal died within 7 minutes of VAE. During autopsy, the heart was open under water and air escaped from the right ventricle.

Conclusion: This in vivo porcine model confirms that during the FAE in PPV, pressurized air from an infusion cannula malpositioned in the suprachoroidal space can transit through the eye to the central circulation, resulting in fatal VAE.
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http://dx.doi.org/10.1016/j.ajo.2016.06.027DOI Listing
November 2016

Intraoperative Management of Increased Intraocular Pressure in a Patient with Glaucoma Undergoing Robotic Prostatectomy in Trendelenburg Position.

A A Case Rep 2016 Jan;6(2):17-8

From the Departments of Anesthesiology and Ophthalmology, University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida.

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http://dx.doi.org/10.1213/XAA.0000000000000233DOI Listing
January 2016

A Novel Issue for Vitreoretinal Surgeons.

Retina 2016 Feb;36(2):245-6

Department of Ophthalmology, Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida.

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http://dx.doi.org/10.1097/IAE.0000000000000763DOI Listing
February 2016

The quest for effective pain control during suture adjustment after strabismus surgery: a study evaluating supplementation of 2% lidocaine with 0.4% ropivacaine.

J Pain Res 2015 14;8:33-7. Epub 2015 Jan 14.

Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: To determine whether the addition of 0.4% ropivacaine to the standard 2% lidocaine peribulbar anesthetic block improves pain scores during suture adjustment in patients undergoing strabismus surgery with adjustable sutures.

Methods: Prospective, double-blind study of 30 adult patients aged 21-84 years scheduled for elective strabismus surgery with adjustable sutures. Patients were divided into two groups of 15 patients each based on the local anesthetic. Group A received 2% lidocaine and Group B received 2% lidocaine/0.4% ropivacaine. Pain was assessed using the visual analog scale (VAS) preoperatively and at 2, 4, and 6 hours postoperatively. The Lancaster red-green test was used to measure ocular motility at the same time points.

Results: The pain scores in the two groups were low and similar at all measurement intervals. The VAS for Group A versus Group B at 2 hours (1.7 versus 2.4, P=0.5) and 4 hours (3.5 versus 3.7, P=0.8) showed no benefit from the addition of ropivacaine. At 6 hours, the VAS (3.7 versus 2.7) was not statistically significant, but the 95% confidence interval indicated that ropivacaine may provide some benefit. A repeated measures ANOVA did not find a statistically significant difference in VAS scores over time (P=0.9). In addition, the duration of akinesia was comparable in both groups (P=0.7).

Conclusion: We conclude that the 50:50 mixture of 2% lidocaine with 0.4% ropivacaine as compared to 2% lidocaine in peribulbar anesthetic blocks in adjustable-suture strabismus surgery does not produce significant improvements in pain control during the postoperative and adjustment phases. In addition, ropivacaine did not impair return of full ocular motility at 6 hours, which is advantageous in adjustable-suture strabismus surgery.
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http://dx.doi.org/10.2147/JPR.S74587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298306PMC
January 2015

The use of perioperative antithrombotics in posterior segment ocular surgery.

Am J Ophthalmol 2014 Nov 14;158(5):858-9. Epub 2014 Oct 14.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.

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http://dx.doi.org/10.1016/j.ajo.2014.08.003DOI Listing
November 2014

Chemosis secondary to anterograde episcleral (sub-tenon) spread of local anesthetic during retrobulbar eye block.

Anesthesiology 2014 Oct;121(4):877

From the Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, University of Miami, Miami, Florida (H.D.P.).

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http://dx.doi.org/10.1097/ALN.0b013e3182a0594bDOI Listing
October 2014

Recombinant hyaluronidase.

Clin Exp Ophthalmol 2014 Apr 29;42(3):298. Epub 2013 Jul 29.

Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA.

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http://dx.doi.org/10.1111/ceo.12154DOI Listing
April 2014

Evaluation of distal radial artery cross-sectional internal diameter in pediatric patients using ultrasound.

Paediatr Anaesth 2013 May 21;23(5):460-2. Epub 2013 Mar 21.

Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, FL 33136, USA.

In this study, we measure the radial artery internal diameter (RAID) in children up to 4 years of age before and after the induction of anesthesia. A B-mode portable color Doppler ultrasound was used to measure the RAID. Three sets of measurements were taken for each child before and after the induction of anesthesia and with the wrist in the neutral and dorsiflexed positions. The reliability of the mean value of the RAID in the three sets in 24 patients was established. There were discrepancies between the RAID and the proposed catheter size in some individuals, which may not only render placement difficult but also have potential for arterial injury. There are good reasons to measure the RAID in small children prior to insertion of an intra-arterial catheter.
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http://dx.doi.org/10.1111/pan.12151DOI Listing
May 2013

Ultrasound investigation and the eye.

Anesthesiology 2012 Dec;117(6):1396-7; author reply 1397

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http://dx.doi.org/10.1097/ALN.0b013e318272d78bDOI Listing
December 2012

Ultrasound-guided eye blocks.

Reg Anesth Pain Med 2012 Nov-Dec;37(6):677-8

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http://dx.doi.org/10.1097/AAP.0b013e3182680bfeDOI Listing
April 2013

Are ultrasound-guided ophthalmic blocks injurious to the eye? A comparative rabbit model study of two ultrasound devices evaluating intraorbital thermal and structural changes.

Anesth Analg 2012 Jul 13;115(1):194-201. Epub 2012 Apr 13.

Department of Anesthesiology, Perioperative Medicine and Pain Management, Miller School of Medicine, 900 NW 17th Street, Miami FL 33136, USA.

Background: Since Atkinson's original description of retrobulbar block in 1936, needle-based anesthetic techniques have become integral to ophthalmic anesthesia. These techniques are unfortunately associated with rare, grave complications such as globe perforation. Ultrasound has gained widespread acceptance for peripheral nerve blockade, but its translation to ocular anesthesia has been hampered because sonic energy, in the guise of thermal or biomechanical insult, is potentially injurious to vulnerable eye tissue. The US Food and Drug Administration (FDA) has defined guidelines for safe use of ultrasound for ophthalmic examination, but most ultrasound devices used by anesthesiologists are not FDA-approved for ocular application because they generate excessive energy. Regulating agencies state that ultrasound examinations can be safely undertaken as long as tissue temperatures do not increase >1.5°C above physiological levels.

Methods: Using a rabbit model, we investigated the thermal and mechanical ocular effects after prolonged ultrasonic exposure to single orbital- and nonorbital-rated devices. In a dual-phase study, aimed at detecting ocular injury, the eyes of 8 rabbits were exposed to continuous 10-minute ultrasound examinations from 2 devices: (1) the Sonosite Micromaxx (nonorbital rated) and (2) the Sonomed VuMax (orbital rated) machines. In phase I, temperatures were continuously monitored via thermocouples implanted within specific eye structures (n = 4). In phase II the eyes were subjected to ultrasonic exposure without surgical intervention (n = 4). All eyes underwent light microscopy examinations, followed at different intervals by histology evaluations conducted by an ophthalmic pathologist.

Results: Temperature changes were monitored in the eyes of 4 rabbits. The nonorbital-rated transducer produced increases in ocular tissue temperature that surpassed the safe limit (increases >1.5°C) in the lens of 3 rabbits (at 5.0, 5.5, and 1.5 minutes) and cornea of 2 rabbits (both at 1.5 minutes). A secondary analysis of temporal temperature differences between the orbital-rated and nonorbital transducers revealed statistically significant differences (Bonferroni-adjusted P < 0.05) in the cornea at 3.5 minutes, the lens at 2.5 minutes, and the vitreous at 4.0 minutes. Light microscopy and histology failed to elicit ocular injury in either group.

Conclusions: The nonorbital-rated ultrasound machine (Sonosite Micromaxx) increases the ocular tissue temperature. A larger study is needed to establish safety. Until then, ophthalmic ultrasound-guided blocks should only be performed with ocular-rated devices.
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http://dx.doi.org/10.1213/ANE.0b013e318253622eDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3381790PMC
July 2012

Can children undergoing ophthalmologic examinations under anesthesia be safely anesthetized without using an IV line?

Clin Ophthalmol 2011 20;5:503-8. Epub 2011 Apr 20.

Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Purpose: To document that with proper patient and procedure selection, children undergoing general inhalational anesthesia for ophthalmologic exams (with or without photos, ultrasound, laser treatment, peri-ocular injection of chemotherapy, suture removal, and/or replacement of ocular prosthesis) can be safely anesthetized without the use of an intravenous (IV) line. Children are rarely anesthetized without IV access placement. We performed a retrospective study to determine our incidence of IV access placement during examinations under anesthesia (EUA) and the incidence of adverse events that required intraoperative IV access placement.

Methods: Data collected from our operating room (OR) information system includes but is not limited to diagnosis, anesthesiologist, surgeon, and location of IV catheter (if applicable), patient's date of birth, actual procedure, and anesthesia/procedure times. We reviewed the OR and anesthetic records of children (>1 month and <10 years) who underwent EUAs between January 1, 2003 and May 31, 2009. We determined the percentage of children who were anesthetized without IV access placement, as well as the incidence of any adverse events that required IV access placement, intraoperatively.

Results: We analyzed data from 3196 procedures performed during a 77-month period. Patients' ages ranged from 1 month to 9 years. Overall, 92% of procedures were performed without IV access placement. Procedure duration ranged from 1-39 minutes. Reasons for IV access placement included parental preference for antinausea medication and/or attending preference for IV access placement. No child who underwent anesthesia without an IV line had an intraoperative adverse event requiring insertion of an IV line.

Conclusion: Our data suggest that for children undergoing general anesthesia for ophthalmologic exams (with or without photos, ultrasound, laser treatment, intraocular injection of chemotherapy, suture removal, and/or replacement of ocular prosthesis), anesthesia can be safely conducted without placement of an IV line.
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http://dx.doi.org/10.2147/OPTH.S18605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3090306PMC
July 2011