FEATURES OF ANESTHESIOLOGICAL MANAGEMENT IN OPHTHALMIC SURGERY

SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 99 FEATURES OF ANESTHESIOLOGICAL MANAGEMENT IN OPHTHALMIC SURGERY D.T. Makhmudova1, L.Yu. Bobokha2 Tashkent State Medical University1,2 https://doi.org/10.5281/zenodo.18065342 Abstract. The given article presents ophthalmic surgical interventions, which require special approaches to anesthesiological management, as even minor changes in systemic hemodynamics, carbon dioxide levels, depth of anesthesia, or intraocular pressure (IOP) can worsen surgical conditions and negatively affect functional outcomes. This article presents current data on the effects of various anesthetics on IOP, discusses the advantages and limitations of regional techniques, highlights the features of general anesthesia in children and adults, and outlines measures to prevent complications, including the oculocardiac reflex, IOP hypertension, and complications of retrobulbar block. Results from international studies of recent decades are systematized, allowing for optimization of clinical approaches and enhanced patient safety. Keywords: ophthalmic surgery, anesthesia, regional block, intraocular pressure, vitreoretinal surgery, oculocardiac reflex. Introduction. It is important to suggest that anesthesiological management of ophthalmologic operations is a complex task that requires a deep understanding of ocular physiology, the interactions between systemic and local drugs, and the specifics of surgical techniques. Features of orbital anatomy, the high sensitivity of the optic nerve to ischemia, the potential for significant IOP fluctuations, and the risk of activating the oculocardiac reflex necessitate careful selection of the anesthesia method [1-5]. Definitely, the primary goal of anesthesiological management in planned ophthalmologic surgeries is to ensure pain-free surgical procedures, rapid recovery, and minimal complications related to anesthesia and surgery. The most commonly performed ophthalmologic procedures include cataract, glaucoma, strabismus, and vitreoretinal surgeries. Certainly, there are various approaches to anesthesiological care for patients undergoing ophthalmic procedures. Anesthesia plans should be patientand procedure-specific, taking into account comorbidities while ensuring cooperation, comfort, and safety. In ophthalmic surgery, the choice of anesthetic technique depends not only on the nature and type of the procedure (duration, extent) but also on the underlying disease that caused the ocular pathology (e.g., diabetes in adults). For example, most ophthalmic surgeries are performed with the patient in the supine position. Comorbid conditions such as heart failure, chronic obstructive pulmonary disease, or obstructive sleep apnea may interfere with positioning the patient in the supine position. A sterile drape used for ophthalmologic procedures may limit access to maintain airway patency in case of intraoperative respiratory compromise. Neurocognitive disorders may hinder patient cooperation and interaction. In children, difficulties in maintaining immobility may occur, and general anesthesia may be helpful. Anesthesia plans may include moderate sedation, monitored anesthetic care, or general anesthesia [5,6]. Types of Anesthesia in Ophthalmic Surgery SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 100 Ophthalmic surgeries can be performed under local or general anesthesia. Local techniques including topical, peribulbar, and sub-Tenon’s anesthesia have been the cornerstone of anesthetic management for cataract and glaucoma surgery over the past decades, as they provide stable intraocular pressure (IOP) and a low incidence of systemic complications [6-10]. Nevertheless, the choice between regional and general anesthesia, as mentioned above, should consider patient age, presence of cognitive impairment, comorbidities, and the extent and duration of the procedure [1113]. Vitreoretinal surgery typically requires general anesthesia, as the prolonged nature of the procedure and the need for complete patient immobility limit the use of local techniques [14-16]. Malignant hyperthermia may be a relative contraindication to general anesthesia. However, proper preoperative planning, including the choice of anesthetic agents and readiness for complications, allows for the safe use of general or local anesthesia in patients at risk of malignant hyperthermia [8]. Surprisingly, absolute contraindications to anesthesia in ophthalmologic procedures include patient refusal. A history of anaphylaxis to local anesthetics may be a relative contraindication to regional blocks. However, true anaphylaxis to lidocaine is extremely rare; most cases are caused by an allergy to the preservative methylparaben. Malignant hyperthermia may be a relative contraindication to general anesthesia. Nevertheless, appropriate preoperative planning, including the selection of anesthetic agents and readiness for potential complications, allows the safe use of general or local anesthesia in patients at risk of malignant hyperthermia [8,9]. The oculocardiac reflex can cause severe bradycardia, hypotension, and asystole. Light anesthesia and certain physiological conditions that may occur during general anesthesia, such as hypoxia and hypercapnia, increase the risk of intraoperative stimulation of this reflex. Pharmacological properties of anesthetic agents play a critical role in ophthalmic surgery. Most intravenous agents, including propofol, thiopental, and etomidate, reduce intraocular pressure (IOP), improving surgical conditions [17-19]. Volatile anesthetics also moderately lower IOP, whereas ketamine may increase it, although evidence regarding its effects is inconsistent [20-21]. Special caution is required with succinylcholine, which causes a short but pronounced rise in IOP, potentially critical in cases of non-penetrating ocular injuries or glaucoma [22]. Regional techniques have several advantages; however, complications of retrobulbar block such as globe perforation, retrobulbar hemorrhage, and anesthetic spread to the central nervous system make it riskier compared to peribulbar or sub-Tenon’s blocks [23-26]. SubTenon’s anesthesia is considered one of the safest techniques, due to the use of a blunt cannula and a reduced likelihood of injury to orbital structures [27]. One of the most significant physiological responses during ophthalmic surgery is the oculocardiac reflex, which can be triggered by tension on the extraocular muscles or pressure on the eyeball, leading to pronounced bradycardia and hypotension [28-29]. Deep anesthesia, adequate premedication, and readiness to administer atropine are key elements of prevention. Additional risks are associated with the use of nitrous oxide. In the presence of an intraocular gas bubble (C₃F₈ or SF₆), commonly used in vitreoretinal surgery, nitrous oxide can cause gas expansion, potentially leading to optic nerve ischemia and irreversible vision loss [30]. Considering the above, optimization of anesthesiological management in ophthalmic surgery should rely on current evidence-based data, an individualized patient approach, and strict monitoring of factors affecting intraocular pressure (IOP) and hemodynamic stability. Conclusion. Anesthesiological management of ophthalmic surgery requires a combination of high-precision technique, appropriate anesthetic selection, and a deep understanding of ocular physiological mechanisms. Modern studies emphasize the need for individualized anesthetic SCIENCE AND INNOVATION INTERNATIONAL SCIENTIFIC JOURNAL VOLUME 4 ISSUE 12 DECEMBER 2025 ISSN: 2181-3337 | SCIENTISTS.UZ 101 approaches aimed at minimizing IOP fluctuations, preventing the oculocardiac reflex, and avoiding complications associated with regional blocks. The application of modern techniques, use of safe pharmacological regimens, and thorough preoperative assessment significantly enhance patient safety and improve outcomes of ophthalmic surgical procedures. REFERENCES 1. Gupta P, Chen A, Stewart JM. Advances in ophthalmic anesthesia risk assessment. Ophthalmology. 2022;129(4):389–398. 2. Lee LA, Patel BC. Modern perioperative considerations in ophthalmic anesthesia. Curr Opin Ophthalmol. 2021;32(3):215–223. 3. 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