This elderly lady in need of a buckle-procedure was wise enough to insist on not having to have GA. She was, apart from arterial hypertension in good health for her “70something” years. She had seen some of her friends go into strange states of mind after surgical procedures and made it quite clear she’d make an effort NOT to go down the same road.
I was enthusiastic about giving her a sub-Tenon, this time using the traditional “scissor-nick”-technique to enable the operating ophthalmologist to top off the block, should the need arise. I allowed for a chemotic cushion to build up, knowing the surgeon would open all of the conjunctiva 10 min later. The discussions in Chennai with so many Indian colleagues encouraged me to use dexmethomidine again. In the past I had used it with infusion-rates I was used to from cardio-thoracic surgery, i.e. the implantation of TAVI etc. This had always resulted in patients sleeping to deeply with occasional moments of coughing, yawning, startled coming to etc-all those things you fear when standing by and your surgeon is a 1/10th mm away from the macula.
But this time everything went astonishingly well, both patients and surgeon were exalted and who am I to not be happy then!?
One article recommended to me by the kind author in Chennai dealing with this subject is the following: