Anaes SAQs · Ophthalmic anaesthesia
Ophthalmic drugs with systemic effects for the anaesthetist
Final-examination SAQ for ophthalmic-drugs-systemic-effects.
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Timolol (4). Ostergaard: timolol 0.25% provoked FEV1 −56% + bradycardia via liver bypass/fast corneal absorption; observe COPD 1 hour.[6] Nanda: systemic absorption/CNS penetration well-studied; common bradycardia/bronchospasm/fatigue/confusion.[7]
Phenylephrine (4). Sbaraglia: 4/187 paediatric (2.1%) haemodynamic — severe hypertension/HR + pulmonary oedema from alpha1; vasodilators useful, beta-blockers negative.[9] Bhatia: 10% drops mostly no significant rise (87%/76%); mild 11%/15%; severe 1/34 hypertensive; precautions in hypertensives.[8]
Anticholinesterase drops (4). Gesztes: prolonged sux apnoea with anticholinesterase eye drops — avoid sux per taught practice; workup includes cholinesterase/dibucaine; dosing per local protocol.[3]
Acetazolamide (3). Bietti: metabolic acidosis causally linked to ocular hypotension.[10] Electrolytes/allergy per local protocol. Absorption/punctal: Salminen rapid absorption, lower levels with occlusion[4]; Müller NLO and tissue-press both lower plasma timolol vs none, no difference[5].
References8ShowHide
- [3]Gesztes T Prolonged apnoea after suxamethonium injection associated with eye drops containing an anticholinesterase agent. British Journal of Anaesthesia, 1966.PMID 5939140
- [4]Salminen L Review: systemic absorption of topically applied ocular drugs in humans. Journal of Ocular Pharmacology, 1990.PMID 2290070
- [5]Müller L, Jensen BP, Bachmann LM, Wong D, Wells AP New technique to reduce systemic side effects of timolol eye drops: The tissue press method-Cross-over clinical trial. Clinical and Experimental Ophthalmology, 2020.PMID 31525271
- [6]Ostergaard Laursen S, Bjerrum P Timolol eyedrop-induced severe bronchospasm. Acta Medica Scandinavica, 1982.PMID 7113767
- [7]Nanda T, Rasool N, Callahan AB, Stamper RL, Odel JG Ophthalmic Timolol Hallucinations: A Case Series and Review of the Literature. Journal of Glaucoma, 2017.PMID 28671925
- [8]Bhatia J, Varghese M, Bhatia A Effect of 10% phenylephrine eye drops on systemic blood pressure in normotensive & hypertensive patient. Oman Medical Journal, 2009.PMID 22303506
- [9]Sbaraglia F, Mores N, Garra R, Giuratrabocchetta G, Lepore D, Molle F Phenylephrine eye drops in pediatric patients undergoing ophthalmic surgery: incidence, presentation, and management of complications during general anesthesia. Paediatric Anaesthesia, 2014.PMID 24354865
- [10]Bietti G, Virno M, Pecori-Giraldi J Acetazolamide, metabolic acidosis, and intraocular pressure. American Journal of Ophthalmology, 1975.PMID 1163584