| FOR CATARACT SURGERY Using The Honan Intraocular Pressure Reducer (Honan Balloon) |
 |
Why Ocular Compression?
Application of the Honan Intraocular Pressure Reducer after retrobulbar or peribulbar injection of anesthetic agent
serves several purposes. It aids in diffusion of the anesthetic agent to paralyze the extraocular muscles. A separate lid
block is not needed. Highly desirable is the resulting soft safe eye for cataract surgery and implantation of an
intraocular lens. Ocular compression reduces the intraocular pressure and in addition reduces the volume of the orbital
contents. This latter desirable result decreases the normal tissue pressure on the globe itself. Thus there is safety in
decreased tendency for expulsion of the ocular contents when the eye is open during intraocular surgery.
When and Where to apply the balloon
Pneumatic Ocular compression can be applied before or after retrobulbar or peribulbar injections of anesthetic agents.
When applied after the injection it aids in diffusion of the anesthetic agent to achieve extraocular muscle paralysis and lid
akinesia. At the same time the ocular compression softens the eye for safe intraocular surgery.
Ocular compression applied prior to the time the patient enters the operating room conserves 0.R. time and allows more
time for it to achieve its desired results. A pre-operative preparation room or a hallway is ideal. Operating room time is
extended when anesthesia is administered in the 0.R. followed by application of pneumatic ocular
compression plus time allowed for it to achieve its results.
How much pressure and how long?
The optimum pressure should be well below the central artery pressure. The lowest pressure to achieve results of a safe
soft eye is desirable.In the 1970's in the days of intracapsular cataract surgery 30rnm Hg pressure was used
for up to 60 or more minutes depending on when 0.R. was available for surgery. Soft safe surgical eyes resulted.
Clinically a pressure of 3Omm Hg for 15 to 20 minutes results in soft safe eyes for planned extracapsular surgery or
phacoemulsification. If several surgeries are scheduled, the anesthesia for the second case can be ad-ministered prior to
doing the first surgery of the day. Adequate results can be achieved by using a pressure of 15mm Hg for the second
case for 30 to 60 minutes or until time for surgery.
When to remove the balloon?
Ocular compression theoretically achieves its globe softening effect by reducing intraocular volume plus reducing orbital
volume. Practically the softening effect lasts long enough to complete the surgery. The start of the return to the normal
state begins as soon as the compression device is removed. For optimum effect the balloon should be removed only
shortly before surgery is started.
When a surgeon is using two operating rooms the nursing personnel like to be ready for the surgeon in the next room.
There may be a tendency to remove the balloon, do the prep
and drape the patient too soon to be certain to be ready for the surgeon. A communication from the surgeon doing
surgery in the other room indicating near completion of the surgery is desirable. Thus in the next room the balloon can
be removed only a few minutes prior to the start of surgery.
Application Technique
1. After retrobulbar or peribulbar injection of anesthesia, tape the lids closed to
avoid gauze touching the cornea.
2. Place a cotton eye pad or a 4"x 4" gauze over the eye.
3. Position the soft pneumatic bellows over the pad and the eye.
4. Secure the bellows loosely in place with the adjustable head band. Apply loosely
enough to prevent putting pressure on the eye before inflating the bellows.
5. Inflate to the desired pressure level.
Disposable or reusable reducer?
Either model produces the same results. The disposable balloon is for a single use. It is clean and ready for use. After
inflating, the air tubing is removed while the bellows remains inflated. Thus there is no bothersome tubing attached to the
bellows.
The headband, bellows and tubing of the reusable model can be disinfected by wiping with a recognized disinfecting
solution. It should not be immersed. It shouldn't be autoclaved or gas sterilized.
The pressure gauge or bulb air pump should not be sterilized. They could be destroyed in the process.
Why a relief valve?
With normal use the pressure gauge records accurately. Unintentional damage by dropping it on the floor or striking it
against a wall might alter its accuracy. Damage to a gauge may be unknown to the surgeon. The relief valve is merely an
added precautionary device to limit to approximately 60mm Hg. the pressure that can be applied to the bellows.
The balloon in general anesthesia
Many surgeons prefer also to use retrobulbar or peribulbar anesthesia when general anesthesia is to be used. There is
added safety in case of retching during recovery from general anesthesia. It also aids in controlling post operative pain.
Induction of anesthesia and intubation usually can be accomplished while the balloon is in position. Thus ocular
compression can be maintained until shortly before the surgery is begun.
The Honan Intraocular Pressure Reducer
Mfg. by The Lebanon Corp.
1700 North Lebanon Street,
Lebanon, Indiana 46052
USA.
Application of the Honan Intraocular Pressure Reducer after retrobulbar or peribulbar injection of anesthetic agent
serves several purposes. It aids in diffusion of the anesthetic agent to paralyze the extraocular muscles. A separate lid
block is not needed. Highly desirable is the resulting soft safe eye for cataract surgery and implantation of an
intraocular lens. Ocular compression reduces the intraocular pressure and in addition reduces the volume of the orbital
contents. This latter desirable result decreases the normal tissue pressure on the globe itself. Thus there is safety in
decreased tendency for expulsion of the ocular contents when the eye is open during intraocular surgery.
When and Where to apply the balloon
Pneumatic Ocular compression can be applied before or after retrobulbar or peribulbar injections of anesthetic agents.
When applied after the injection it aids in diffusion of the anesthetic agent to achieve extraocular muscle paralysis and lid
akinesia. At the same time the ocular compression softens the eye for safe intraocular surgery.
Ocular compression applied prior to the time the patient enters the operating room conserves 0.R. time and allows more
time for it to achieve its desired results. A pre-operative preparation room or a hallway is ideal. Operating room time is
extended when anesthesia is administered in the 0.R. followed by application of pneumatic ocular
compression plus time allowed for it to achieve its results.
How much pressure and how long?
The optimum pressure should be well below the central artery pressure. The lowest pressure to achieve results of a safe
soft eye is desirable.In the 1970's in the days of intracapsular cataract surgery 30rnm Hg pressure was used
for up to 60 or more minutes depending on when 0.R. was available for surgery. Soft safe surgical eyes resulted.
Clinically a pressure of 3Omm Hg for 15 to 20 minutes results in soft safe eyes for planned extracapsular surgery or
phacoemulsification. If several surgeries are scheduled, the anesthesia for the second case can be ad-ministered prior to
doing the first surgery of the day. Adequate results can be achieved by using a pressure of 15mm Hg for the second
case for 30 to 60 minutes or until time for surgery.
When to remove the balloon?
Ocular compression theoretically achieves its globe softening effect by reducing intraocular volume plus reducing orbital
volume. Practically the softening effect lasts long enough to complete the surgery. The start of the return to the normal
state begins as soon as the compression device is removed. For optimum effect the balloon should be removed only
shortly before surgery is started.
When a surgeon is using two operating rooms the nursing personnel like to be ready for the surgeon in the next room.
There may be a tendency to remove the balloon, do the prep
and drape the patient too soon to be certain to be ready for the surgeon. A communication from the surgeon doing
surgery in the other room indicating near completion of the surgery is desirable. Thus in the next room the balloon can
be removed only a few minutes prior to the start of surgery.
Application Technique
1. After retrobulbar or peribulbar injection of anesthesia, tape the lids closed to
avoid gauze touching the cornea.
2. Place a cotton eye pad or a 4"x 4" gauze over the eye.
3. Position the soft pneumatic bellows over the pad and the eye.
4. Secure the bellows loosely in place with the adjustable head band. Apply loosely
enough to prevent putting pressure on the eye before inflating the bellows.
5. Inflate to the desired pressure level.
Disposable or reusable reducer?
Either model produces the same results. The disposable balloon is for a single use. It is clean and ready for use. After
inflating, the air tubing is removed while the bellows remains inflated. Thus there is no bothersome tubing attached to the
bellows.
The headband, bellows and tubing of the reusable model can be disinfected by wiping with a recognized disinfecting
solution. It should not be immersed. It shouldn't be autoclaved or gas sterilized.
The pressure gauge or bulb air pump should not be sterilized. They could be destroyed in the process.
Why a relief valve?
With normal use the pressure gauge records accurately. Unintentional damage by dropping it on the floor or striking it
against a wall might alter its accuracy. Damage to a gauge may be unknown to the surgeon. The relief valve is merely an
added precautionary device to limit to approximately 60mm Hg. the pressure that can be applied to the bellows.
The balloon in general anesthesia
Many surgeons prefer also to use retrobulbar or peribulbar anesthesia when general anesthesia is to be used. There is
added safety in case of retching during recovery from general anesthesia. It also aids in controlling post operative pain.
Induction of anesthesia and intubation usually can be accomplished while the balloon is in position. Thus ocular
compression can be maintained until shortly before the surgery is begun.
The Honan Intraocular Pressure Reducer
Mfg. by The Lebanon Corp.
1700 North Lebanon Street,
Lebanon, Indiana 46052
USA.