Anesthetic Considerations in the Evaluation of Children with Glaucoma and Associated Conditions

Glaucoma in the pediatric population can be difficult to diagnose and treat without a child’s cooperation. Examination and intervention under anesthesia play a critical role in the management of childhood glaucoma, as detailed elsewhere. This requires a change in setting from the office to the operating room with the availability and assistance of a pediatric anesthesiologist, who may have to sedate or anesthetize the child repeatedly, sometimes even just to confirm the glaucoma diagnosis. An anesthesiologist with specialty training in pediatrics is pertinent, as childhood glaucoma can often be associated with syndromes involving other organ systems, hence making their anesthetic complicated and at times potentially dangerous. Once the glaucoma diagnosis is established, these children may have to return to the operating room multiple times for examinations and/or treatments; thus, having prior anesthetic records with any previous complications can offer vital information to both the pediatric anesthesiologist and pediatric glaucoma specialist. This chapter focuses on the preoperative workup of pediatric patients to ensure that they are optimized medically to undergo sedation and general anesthesia with the lowest possible risk. The intraoperative course is also described, including why sedation may be chosen over general anesthesia and how the various anesthetic drugs such as volatile anesthetics or intravenous induction agents can affect intraocular pressure measurements. The chapter finishes by describing potential postoperative complications related to anesthesia: nausea, vomiting, postoperative delirium, and agitation, along with a brief discussion on various syndromes that could potentially affect the delivery and choice of anesthetic