Supine, table rotated 90-180 degrees

Opthalmic Surgical Procedures

1.5-3.0 ml/kg/hr

Intermittent bolus injections of midazolam (0.25-1.0) ___mg with/without fentanyl (10-25) ___mcg titrated to effect.

Or

Propofol infusion (25-100) ___ mcg/kg/min.

Assess the patient for PONV

Symptoms may develop secondary to anesthesia.

1. Excessive fluids can cause bladder distension and lead to increased blood pressure.

2. Pt may become unresponsive to verbal communication and have a decreased respiratory drive from over-sedation.

3. Positioning of patient may cause strain to their back.

4. Pt may develop dysrhythmias and bradycardia secondary to traction on extraocular muscles.

5. Retrobulbar hemorrhage.

6. Convulsions secondary to iv local anesthetic.

7. Respiratory arrest secondary to subarachnoid injection.

8. Marked bradycardia and hypotension from oculocardiac reflex.

1. Strictly monitor rate and amount of ivf replacement.

2. Regularly communicate with the patient to assess their level of sedation while assuring that they do not move their head during the procedure.

3. Check and pad the patient's pressure points and nonoperated eye.

4. Treatment includes, releasing tension on the extraocular muscles and administration of vagolytic agents (atropine and glycopyrrolate).

5. Pressure dressing and usually canceling surgery.

6. Supportive treatment with IPPV.

7. CPR

8. Have surgeon stop stimulation and administer atropine.

The midazolam will act to relax the patient and the fentanyl will provide the patient with analgesia.

Propofol will have an amnesiac and sedative effect on the patient.