Position: Supine, arms tucked, Bed turned 180 degrees
Time: 1-2 hours (average)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

Preoperative Period – Strabismus surgery is associated with an increased risk of PONV. Sharing this information with the patient can be helpful, as it prepares them for what to expect postoperatively.

Anesthetic Approach – The bed will be turned 180 degrees and the face will be draped so airway access is VERY limited. For this reason, GETT is the most common choice for this procedure. GLMA may be used (literature varies on this), but is not a common practice.

PONV Prophylaxis – Standard measures should be taken to prevent PONV (4 – 8 mg Decadron at induction and 4 – 8 mg Zofran prior to emergence). The use of a scopolamine patch for PONV prophylaxis in strabismus surgery is controversial due to the potential for CNS side effects. Check with the surgeon prior to the use of a scopolamine patch.

Pain Management – Intraoperative administration of 15 – 30 mg Ketorolac is associated with decreased intra/postoperative pain and helps to reduce PONV. Check with the surgeon prior to administering.

Emergence – Standard wakeup. Sometimes the surgeon uses adjustable sutures and may want the patient awake to do some last-minute adjustments.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

180 degree turns (general considerations): Arrange lines and monitor cords in anticipation to turn. If turning right, keep cords and lines draped to the left. If turning left, keep cords and lines draped to the right. Have a circuit extension connected. Disconnect the circuit when turning and immediately reconnect.

Strabismus is defined as a misalignment of the eyes and may present in varying forms (hypertropia, esotropia, etc.). The most common population affected is infants and children, but the condition may develop at any age. Strabismus may be caused by eye injury, stroke, genetic predisposition, diabetes, and several other conditions. Most frequently it is idiopathic in nature.

The surgeon (e.g. ophthalmologist) will manipulate the muscles of the eye and realign them into the correct position.