# Anesthesia Strategies for Pediatric Ophthalmic Patients: Systematic Review of Recent Advances and Updates

## TL;DR

This paper reviews recent developments in anesthesia for children undergoing eye surgery, focusing on safer and more personalized techniques.

## Contribution

The paper provides updated strategies for managing anesthesia in pediatric ophthalmic patients, including alternatives to reduce risks and improve outcomes.

## Key findings

- Multimodal approaches like sub-Tenon’s blocks and methadone reduce emergence delirium.
- Low-risk EUA cases can be managed without IV access or general anesthesia.
- Alternative methods for ROP care include laryngeal mask airways and sedation-based laser procedures.

## Abstract

This review summarizes recent advances in pediatric ophthalmic anesthesia, focusing on emergence agitation, examination under anesthesia (EUA), anesthesia strategies for retinopathy of prematurity (ROP), and care for children with developmental or medical comorbidities.

Emerging evidence supports multimodal approaches to reduce emergence delirium, including sub-Tenon’s blocks with dexmedetomidine and intraoperative methadone. EUA protocols now emphasize streamlined exams under a single anesthetic, with some low-risk cases managed without intravenous access or general anesthesia. In ROP care, alternative strategies such as laryngeal mask airway use and bedside laser under sedation are being explored. Concerns over neurodevelopmental risks are also prompting efforts to limit cumulative anesthetic exposure through coordinated care.

Pediatric ophthalmic anesthesia is evolving toward safer, more individualized approaches. Incorporating targeted techniques and minimizing exposure can improve outcomes and inform best practices in this vulnerable population.