Special aspects of pediatric anesthesia in ophthalmic surgery

In ophthalmic surgery, children are anesthetized for various reasons. The airway needs special attention as children have higher oxygen requirements and brief periods of apnea can result in hypoxemia and subsequent bradycardia or even cardiac arrest. Most interventions can be managed with the aid of a laryngeal mask allowing minor airway manipulations and thereby reducing the risk of laryngeal and tracheal injuries and laryngospasm in children with hypersensitive airways. In children older than 3 years an adequate postoperative nausea and vomiting (PONV) prophylaxis should be performed. The modified postoperative vomiting in children (POVOC) score is a suitable method for the estimation of PONV. Strabismus surgery is an independent risk factor for PONV; therefore, prophylaxis is recommended in any case. The combination of drugs from different substance groups amplifies the antiemetic effect. This article discusses whether anesthesia can damage immature brains. In animal experiments it could be proven that neuronal apoptosis could be induced by most of the commonly used anesthetics. It has not yet been clarified whether this has an effect on the neurocognitive development of children. Because of this uncertainty the indications for surgery and anesthesia should be assessed on strict clinical requirements. There is, however, widespread agreement that a necessary anesthesia carried out in a correct and controlled manner has no negative consequences for children.