Conference Lectures

Role of Supra-glottic airway devices in ophthalmic anaesthesia

Dr. A. Ravichandar
Consultant Anaesthesiolagist
Aravind Eye Hospital
Madurai - TN                                                                                                
Clinical assessment that determines the treatment course and the ophthalmic surgery often cannot be performed without the aid of General Anaesthesia. Ophthalmologist should be familiar with the anaesthetic safety. Patient safety is the paramount consideration but that will be balanced by the knowledge of the surgical team and the experience of the Anaesthesiologist.
Supraglottic airway devices are now being increasingly used with success in ophthalmic procedures.  Flexible devices are more appropriate, but they are not recommended in Nasolacrimal surgical procedures.
Laryngeal mask airway (LMA): introduced by Dr.Brain in 1988 in United Kingdom (UK) and marketed in United States (US) in 1991 is the most commonly employed device, apart from ProSeal LMA, LMA Supreme, I- gel, LMA fastrach
Elective ophthalmic procedures performed under general anaesthesia, usually lasting < 2 hours are common selection criteria for employing supra glottis airway.
Supraglottic airways have several advantages over intubation with endotracheal tube – these are quicker and easier to introduce, with or without need for a muscle relaxant. They also result in reduced anaesthetic requirements, reduced laryngeal and subglottic trauma, reduced cardiovascular disturbances during introduction and removal as well as least changes in the intracranial and intraocular pressures. Laryngeal competence and mucociliary function is preserved better with reduction in incidence of hoarseness of voice, sore throat, swallowing disturbances, pain, nausea and vomiting with considerable reduction in the length of post anaesthetic care unit (PACU) stay.
From the providers’ aspect too, supraglottic airway administration has several advantages: apart from providing better airway control, it is easier to learn and use, frees anaesthetists’ hands and reduces fatigue, decreases need for jaw support or oral airway and reduces risk of pressure over eyes.
Control of IOP and stability of haemodynamic responses are the predominant requisite of ophthalmic procedures.
The Supra-glottic airway devices do not increase IOP and provides haemodynamic stability with minimal response in all ophthalmic surgery particularly in paediatric IOL, squint correction and glaucoma procedures.