title: Ocular risk management in patients undergoing general anesthesia: an analysis of 39,431 surgeries.
abstract: OBJECTIVE
  This study sought to describe and analyze ocular findings associated with nonocular surgery in patients who underwent general anesthesia.
  
  
  METHODS
  The authors retrospectively collected a series of 39,431 surgeries using standardized data forms.
  
  
  RESULTS
  Ocular findings were reported in 9 cases (2.3:10,000), which involved patients with a mean age of 58.9±19.5 years. These cases involved patients classified as ASA I (33%), ASA II (55%) or ASA III (11%). General anesthesia with propofol and remifentanil was used in 4 cases, balanced general anesthesia was used in 4 cases, and regional block was used in combination with balanced general anesthesia in one case. Five patients (55%) underwent surgery in the supine position, one patient (11%) underwent surgery in the lithotomy position, two patients (22%) underwent surgery in the prone position, and one patient (11%) underwent surgery in the lateral position. Ocular hyperemia was detected in most (77%) of the 9 cases with ocular findings; pain/burning of the eyes, visual impairment, eye discharge and photophobia were observed in 55%, 11%, 11% and 11%, respectively, of these 9 cases. No cases involved permanent ocular injury or vision loss.
  
  
  CONCLUSIONS
  Ophthalmological findings after surgeries were uncommon, and most of the included patients were relatively healthy. Minor complications, such as dehydration or superficial ocular trauma, should be prevented by following systematic protocols that provide appropriate ocular occlusion with a lubricating ointment and protect the eye with an acrylic occluder. These procedures will refine the quality of anesthesia services and avoid discomfort among patients, surgeons and anesthesia staff.
authors.affiliation: Sírio-Libanês Hospital, São Paulo, SP, Brazil.
authors.forename: Newton
authors.initials: N
authors.lastname: Kara-Junior
authors.affiliation: Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rodrigo França de
authors.initials: RF
authors.lastname: Espindola
authors.affiliation: Sírio-Libanês Hospital, São Paulo, SP, Brazil.
authors.forename: Joao
authors.initials: J
authors.lastname: Valverde Filho
authors.affiliation: Sírio-Libanês Hospital, São Paulo, SP, Brazil.
authors.forename: Christiane Pellegrino
authors.initials: CP
authors.lastname: Rosa
authors.affiliation: Sírio-Libanês Hospital, São Paulo, SP, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Ottoboni
authors.affiliation: Sírio-Libanês Hospital, São Paulo, SP, Brazil.
authors.forename: Enis Donizete
authors.initials: ED
authors.lastname: Silva
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005128:Eye Diseases / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D065346:Lubricant Eye Drops / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects; D010880:Piperidines / Q000009:adverse effects; D011183:Postoperative Complications / Q000517:prevention & control*; D015742:Propofol / Q000009:adverse effects; D000077208:Remifentanil; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D065346:Lubricant Eye Drops; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol