National Board Ex- 6 Book .pmd - National Board Of Examination

lControl ventilation should beinitiated during the procedureaiming for low to normal endtidalcarbon dioxide withlonger acting muscle relaxantalong with neuromuscularmonitoring. A slight head uptilt helps reduce IOP.be given to control pain.Congenital syndromes witheye involvementDown syndromeCrouzon's syndromelAt the end of the procedure,the patient should beextubated on their side andonce airway protectivereflexes have returned. Inpatients not deemed at risk ofaspiration, extubation with thepatient deep and breathingspontaneously may preventcoughing. Intravenouslignocaine1.5mg/kg orremifentanil 0.5µg/kg 3-5mins before extubation canhelp in prevention ofcoughing and straining as thisincreases the risk of ocularhaemorrhage.These patients may have strabismus,cataract, mental retardation,congenital heart defects (CHD),macroglossia, atlantoaxial instability,hypothyroidism, hypotoniaand seizure disorderTheses patients may have glaucoma,cataract, strabismus, proptosis,hypertelorism craniofacialabnormalities, possible difficultintubation and elevated intracranialpressure.Goldenhar syndromellIf the patient does not havea full stomach, generalanaesthesia should proceed asfor an elective patient. Ifavailable laryngeal maskairway insertion will preventlaryngoscopy and intubationi.e. increase in IOP.Post operatively nausea,vomiting and pain should bekept to a minimum as they cancause rises in intra-ocularpressure. Oral analgesia andan anti-emetic should beadministered. Some patientsmay need stronger analgesiaearly after surgery i.e. titratedsmall doses of intravenousopioid (fentanyl, alfentanil,morphine, pethidine) shouldSturge-weber syndromeThese patients have secondaryglaucoma along with cavernouscutaneous hemangiomas of theface, ectopia lentis, cerebral cortexand lower airway, CHD andhigh output failure and seizuredisorder.These patients may haveglaucoma, cataract, strabismus, lidcoloboma, lacrimal duct defects,hemifacial microsomia, possiblecervical spine abnormalities,possible difficult mask ventilationand intubation, hydrocephalus,preauricular tag and rare CHD.Marfan syndrome - Thesepatients may have subluxatedlenses, retinal detachment,cataract, strabismus, heart valvedefects, thoracic aneurysm andkyphoscoliosis.32Journal of Postgraduate Medical Education, Training & ResearchVol. II, No. 5, September-October 2007