Insertion In Intraocular Surgery

DISCUSSION
The Main anesthetic goal in Intraocular surgery is the maintenance of a stable intraocular pressure, as the sudden raise in Intraocular pressure during open eye surgery can cause prolapse of iris or lens and vitreous loss leading to permanent loss of vision. Conventional laryngoscopy with general anesthesia is usually practised in paediatric patients coming for Intraocular procedure.
This causes sympathetic stimulation with resultant increase in IOP, with associated raise in MAP & HR.
There are few studies conducted in children to compare the effect of insertion of LMA with endotra-cheal intubation on IOP. But there are a number of studies done on adults, to confirm that LMA serves as an effective alternative to endotracheal intubation.

In the OPD, the pre-operative IOP was recorded in children using I-care or Tonopen as these require much less co-operation from children. The baseline IOP was recorded only after induction with 4% topical lignocaine drops applied in the non-operating eye alone.
This method avoids introduction of any infection into the well prepared operated eye. Since, children do not co-operate to measure the baseline IOP inside operation theatre, it is usually done after induction of anesthesia. From ur study, we found that there is no significant rise in IOP with LMA insertion whereas ETT intubation produced a significant raise which persisted for two minutes.
Today, LMA has come to be widely used as an alternative airway device during daycare anesthesia. The LMA has become a very attractive alternative to endotracheal tube.
In this study, the efficacy of LMA in reducing IOP during ophthalmic surgeries in children is compared with that of conventional endotracheal

The raise in IOP with endotracheal intubation is tolerated to some extent in normal eye, but may produce deleterious effect in patients with already raised IOP like acute angle closure glaucoma or in children with penetrating eye injury. Even a small raise in IOP for a short time may cause optic disc ischaemia resulting in blindness in acute angle closure glaucoma, whereas in penetrating eye injury, expulsion of intraocular contents occurs. In chronic glaucoma the incidence of loss of central vision is about 30%. When the IOP raises above 20 mmHg., whereas the incidence is less when IOP is below 18 mmHg.
In our study, the mean maximal IOP raise was less in LMA group when compared with ETT group during intubation. The variation in IOP at different time points was greater in ETT group when compared to LMA group. The hemodynamic changes correlated with changes in IOP in both the groups. In most of the cases in our study, tracheal intubation produced a raise in HR, MAP whereas LMA insertion was not associated with rise in these