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Strabismus Surgery 




  • Affects 3-5% of the population, most patients are ASA 1 & 2

    • occasional association with syndrome (e.g. Trisomy 21)

  • Age ranges anywhere from neonate to teenagers (and older if

  • Surgery requires tightening, lengthening, transposing or shortening the extra-ocular muscles




  • Potential for perioperative anxiety as patients may require multiple procedures

  • Limited access to head

  • Avoid succinycholine/ketamine (potential for increased IOP)

  • Avoid coughing on emergence

  • Potential for oculocardiac reflex and resultant bradycardia

    • Risk for sinus arrest

    • Consider sub-Tenon's block at the start of surgery to prevent the reflex

    • Management:

      • notify surgeon to release traction/pressure on globe

      • 10 mcg/kg glycopyrrolate IV bolus 

  • High risk for PONV  

    • Especially in patients older than 3

    • Consider:

      • dual-therapy prophylaxis: ondansetron and dexamethasone

      • TIVA

  • Relatively painful procedure:

    • Patients will need long-acting opioids (hydromorphone/morphine) post-op

    • Surgeon should perform sub-Tenon's block at the end of surgery

    • Multi-modal analgesia with Tylenol and NSAIDs

  • Potential comorbid conditions:

    • Craniosynostosis (Apert/Pfeiffer/Crouzon syndromes)

    • Craniofacial abnormalities (Treacher Collins/Goldenhar syndromes)

    • Trisomy 21

    • Edward's syndrome

  • Ocular myopathies rarely associated with malignant hyperthermia

    • Avoid succinycholine

    • Employ temperature monitoring




  • Lewis H, James I. Update on anaesthesia for paediatric ophthalmic surgery. BJA Educ. 2021 Jan;21(1):32-38. doi: 10.1016/j.bjae.2020.09.002. Epub 2020 Nov 5. PMID: 33456972; PMCID: PMC7808067.

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