Open-globe and penetrating eye injury anaesthesia

Model answer

Trade-off (5). Aspiration and coughing dominate over a brief suxamethonium rise of roughly 10 mmHg (about 15 to about 25), so suxamethonium is not an absolute contraindication when the stomach is full — the teaching has been traced through the literature and the question of whether an alternative is even necessary explicitly published.^[1][3][4] Extraocular muscle contraction does not contribute to the rise.^[3]

Technique (5). Rapid-sequence induction per local protocol: preoxygenation with cricoid pressure, an IOP-sparing relaxant technique — non-depolarising relaxants lower IOP; suxamethonium peaks at 2 to 4 minutes and returns to baseline by about 6 minutes — with sugammadex backup when high-dose rocuronium is chosen and surgeon readiness before induction.^[2] Avoid ketamine when pressure matters (the exception to volatile IOP reduction); blunt airway reflexes; multimodal antiemesis.^[2]

Emergence (5). Plan deep-versus-awake individually against aspiration risk; smooth emergence without bucking, quiet recovery, eye shield, pain control without straining — emergence coughing undoes a careful induction.^[1][2]