Trabeculectomy / Glaucoma Surgery
Patient phenotype
Open-angle or angle-closure glaucoma, often elderly, on multiple eye drops (timolol = systemic beta-blocker absorption). Diabetes, HTN common.
Procedure
MAC + retrobulbar/peribulbar block standard. Conjunctival flap, scleral flap, removal of trabecular tissue, creation of bleb for aqueous outflow. ~30-60 min.
Anesthetic plan
MAC. Light sedation only (cooperation needed). Avoid coughing/movement. Avoid IOP spikes.
Setup
- ·Standard monitors
- ·PIV
- ·O₂ via NC under drape (low flow)
- ·Capnography under drape
Biggest concerns by phase
Topical beta-blocker systemic absorption
Timolol drops absorbed → bradycardia, bronchospasm, fatigue. Document HR + ask about asthma. Glaucoma drops continued perioperatively.
IOP control — avoid spike
Coughing, vomiting, bucking → IOP spike → ocular damage with open eye. Smooth sedation (small remi or dex). Avoid succinylcholine (transient IOP rise — but acceptable in non-perforated eye).
Oculocardiac reflex
Same as other eye surgery. Atropine ready.
Smooth + no Valsalva
Cough, gag, vomit = bleb disruption. Antiemetic. Avoid PEEP at home.
Mock-defense scenarios
Practice answering these out loud. The probes show what an examiner is listening for.
75-yo with COPD, on home O2, glaucoma on timolol + latanoprost + brimonidine, advanced visual field loss. Trabeculectomy planned. Plan?
What an examiner probes for
- ▹Topical beta-blocker systemic absorption awareness
- ▹MAC with minimal sedation
- ▹OCR + IOP management
- ▹Smooth emergence
Sources
- Miller's Ch 65
- Anesthesia for Ophthalmic Surgery 2e
Anatomy reference
Sourced reference images. 4 matches for "eye orbital ophthalmic".
