A 3-year-old boy is eating a happy meal on the lawn of the restaurant. A lawn mower approaches, and a rock is ejected from the mower, hitting the child in the eye. The boy suffers a penetrating open eye injury and is taken to the nearest hospital. What Should be the course of action, being an experienced practitioner but not a pediatric anesthetic specialist?
Discussion: Two separate issues involved are: How to safely perform the open-eye, full stomach anesthetic The performance of pediatric anesthesia by non-pediatric anesthesia specialists The goals for this anesthetic are to protect the airway and to avoid increases in intraocular pressure (IOP). Sudden increases in IOP in patients with an open globe injury can lead to vitreous loss and blindness. The list of things that increase IOP and risk further eye damage includes crying, coughing, the Valsalva maneuver, vomiting, firm pressure…
