Laser Eye Surgery

prmenrs, RN · Nov 17, 2005

I don't know what happens now, but we used to intubate them and anesthesia put them to sleep. Could be a problem if they were chronic lung types, but at least they slept thru it and didn't move!

Navy1Nurse · Nov 18, 2005

Chloral Hydrate 50mg/kg for sedation, and Tylenol prn pain, possibly some versed/fentanyl. Chloral Hydrate is not analgesic so you have to add something, the recovery period is usually a few days, maybe a week.

Here is a useful link on ROP, good for the parents:

http://www.charles-retina.com/rop-faq.htm

Greg H.

RNC(h)

Gompers, BSN, RN · Nov 22, 2005

Wow, just sedation for laser?!?!

Our eye docs don't want the eye balls even moving so they have a good shot with each zap - how in the world do you accomplish that with a baby that is just sedated and not OUT? We completely put them under - rapid sequence intubation, pavulon every hour during the procedure, and morphine/fentanyl boluses throughout. Yeah, some of the BPD kids might take a day or two to come back off the vent, but I can't imagine shooting laser beams at the eyes of a baby that can move his eyeballs, not to mention the rest of his body.

We do the surgery back in our isolation room in the evening, and most babies are extubated by morning. As soon as the pavulon wears off, we start weaning. Morphine for pain while intubated (per unit protocol for any intubated babies) and then Tylenol afterwards if they seem uncomfortable. When bowel sounds return, NG feedings are resumed, and they can PO again a couple hours after extubation.

prmenrs, RN · Nov 23, 2005

I'm w/you, Gompers! No wiggling!!

BittyBabyGrower, MSN, RN · Nov 23, 2005

Interesting...but we are trying to totally avoid that as we are taking kids from the outside also and we don't want them with us for weeks in isolation. They are talking about using the deep sedation, but crimany, with our census at capacity for the last month, this just isn't doable and PICU won't take them and the outpatient won't either. And laser surgery really does not hurt...you have a splitting headache for the first day, but then after that is just aching...I know this from personal experience LOL. The ones in the unit, they are usually still intubated and that isn't a problem...we can send them into lala, but the others....

What do your units do with the kids that have to come back in?

KK7724 · Nov 23, 2005

It's usually done on day shift, but depending on how bad the baby's eyes are...they are usually done in a special exam room in the unit. They are intubated and given fentanyl usually...and I'll add...it's usually the staff nurse that intubates and pushes the fentanyl. I got certified to give fentanyl in regular hospital orientation!!! Gotta love Alabama!

prmenrs, RN · Nov 23, 2005

I don't quite see how a "splitting headache" for the 1st day constitutes not hurting, esp. when you can't explain it to the pt. JMHO.

We used to bring kids from other hospitals to have laser proceedures. They still got put to sleep.

Gompers, BSN, RN · Nov 23, 2005

Interesting...but we are trying to totally avoid that as we are taking kids from the outside also and we don't want them with us for weeks in isolation. They are talking about using the deep sedation, but crimany, with our census at capacity for the last month, this just isn't doable and PICU won't take them and the outpatient won't either. And laser surgery really does not hurt...you have a splitting headache for the first day, but then after that is just aching...I know this from personal experience LOL. The ones in the unit, they are usually still intubated and that isn't a problem...we can send them into lala, but the others....
What do your units do with the kids that have to come back in?

We're the only place in the whole hospital that does this type of surgery, so all the babies come back to us. It's almost always one of our graduates, because our eye docs usually only see babies from our hospital. About 75% of the time the baby is still in the NICU, so it's not that often we get an "outsider" that has graduated. They are admitted to the isolation room, since that's where the surgery will be anyways. During RSV season, they get a quick swab test and within a few hours they are cleared to be with the rest of the babies. There really is no reason to keep them isolated otherwise - in seven years I've never seen them bring anything into the unit that hurt the other babies. We still do full intubation/pavulonization no matter what. Seriously, the longest I've seen a baby stay intubated is like 2-3 days and that's with severe BPD. Usually it's only about 12 hours, and the "outsider" babies are the healthiest at the time of surgery so they usually are the quickest to extubate anyways. They only stay about 2 days total - one day for surgery, one day for recovery and making sure they're feeding well.

Also remember that Lasik surgery is different than ROP surgery. The laser is doing different things, so you don't know for sure what that baby is feeling. Plus since we intubate and pavulonize, we really knock those babies out because it's cruel to paralyze and not sedate them. Plus, like I said, any intubated baby is supposed to get fentanyl or morphine ATC, house rules.

BittyBabyGrower, MSN, RN · Nov 23, 2005

I didn't have Lasik...I had a detaching retina, so it is a lot similar. So if you all are doing this, I wonder why our eye docs don't. I'll have to ask. Thanks :)

Mulan · Nov 23, 2005

What kind of laser eye surgery do they do on babies?

prmenrs, RN · Nov 23, 2005

http://www.stlukeseye.com/Conditions/ROP.asp