Using Anestheisia in examining Small children

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Mike Bartolatz
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Using Anestheisia in examining Small children

Post by Mike Bartolatz »

Below is a converstion that Dr Foster had with a parent regarding how to examin a small child. I repost it here so that other parents will benefit from his wisdom:

____(used by permission of C Stephen Foster MD of the Ocular Immunology and Uveitis Foundation, Cambridge, MA USA )___________________________________________________________________


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Using general anesthesia to examine young children Q24
My daughter was diagnosed with Uveitis, when she was 2 1/2. She is now 5 1/2. She is not yet at the point where she stays completely still for her eye exams, which are monthly. So far she has been under General Anesthesia, twice. Now the ophthalmologist wants to do it again. It has been every 6 months for the past 1 1/2 years. I want to find out if this is common, to be put under so often. I am nervous about this, and feel she is being used as an experiment. HELP!

Hope my wording is clear.

Unsigned (4/2/2001)

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Dear Sir or Madam:

It sounds as if your daughter is under the care of someone who truly cares, and wants to be certain that he or she can adequately examine the eyes, dilate the pupils, look for cataract, examine the retina, check the pressure, etc. And examinations under anesthesia are common for delivering proper care to children who cannot adequately cooperate. Sometimes that examinations after corneal transplantation occur every 2 weeks for a while.

However, I would emphasize the following two points:

You can help teach your child to be cooperative in the office examination by playing a game of "Eye Doctor" each day at home. Use the kitchen table or something more creative, having your child practice placing her chin on the edge of the table, while you shine a flashlight, moving it slowly across the eye, back and forth, emphasizing to her the importance of remaining perfectly still, looking straight ahead, not following the light with her eyes. Once she has learned to cooperate in this game for approximately 60 seconds with each eye being "examined", it is a very small step to extend this "practice and play" game at home to the real thing at the slit lamp in the darkened doctor's office.


The doctor will no be able to judge whether or not there are inflammatory cells in the anterior chamber when your child is under general anesthesia, examining her through the operating microscope or with the indirect ophthalmoscope; only a slit lamp can enable him or her to do that, and it is unlikely that he or she has such a slit lamp available in the operating room, equipped to be used on a patient who is lying down. Therefore, it is very important for this reason too, not just the avoidance of multiple anesthesias, to get your little girl accustomed to cooperating with the office examination.


The doctor will not be able to judge whether or not there are inflammatory cells in the anterior chamber when your child is under general anesthesia, examining her through the operating microscope or with the indirect ophthalmoscope; only a slit lamp can enable him or her to do that, and it is unlikely that he or she has such a slit lamp available in the operating room, equipped to be used on a patient who is lying down. Therefore, it is very important for this reason too, not just the avoidance of multiple anesthesias, to get your little girl accustomed to cooperating with the office examination.


Sincerely Yours,

C. Stephen Foster, M.D. (4/2/2001)
Mike Bartolatz
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