Abstract
Introduction: The anesthetic care of this pediatric patient with coloboma and indication for surgical intervention due to a dog bite injury is discussed in this case report. Coloboma can be part of several syndromes, and thus, perioperative risk for complications is increased, particularly elevated intraocular pressure during airway manipulation.
Case Presentation: We selected Total Intravenous Anesthesia using a propofol-based general anesthetic without inhalational agents. We did this to maintain hemodynamic stability and circumvent the specific risks associated with coloboma. We selected Total Intravenous Anesthesia because it has been demonstrated to be capable of providing controlled anesthesia without increasing intraocular pressure, a vital consideration in this case.
Discussion: The successful management of this complex case demonstrates the central role of personalized anesthetic planning in obtaining better outcomes for pediatric trauma patients with specific congenital anomalies. Total Intravenous Anesthesia proved effective in maintaining controlled anesthesia while minimizing the risk of raised intraocular pressure.
Conclusion: This case serves as a reminder of the necessity of having an overall understanding of unusual congenital disorders like coloboma in the context of trauma. It is also a reminder of the critical role that the anesthesiologist plays in ensuring perioperative safety and the success of surgery. The contribution of the anesthesiologist is not only necessary but integral to the medical team, and this case serves as a reminder of that fact.
References
Vegunta S, Patel BC. Optic Nerve Coloboma. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532877/
Goel L, Bennur SK, Jambhale S. Treacher-collins syndrome-a challenge for anaesthesiologists. Indian J Anaesth. 2009 Aug;53(4):496–500. PMID: 20640217; PMCID: PMC2894488.
Senthil, S., Nakka, M., Rout, U., Ali, H., Choudhari, N., Badakere, S., & Garudadri, C. (2021). Changes in intraocular pressures associated with inhalational and mixed anesthetic agents currently used in ophthalmic surgery. Indian journal of ophthalmology, 69(7), 1808–1814. https://doi.org/10.4103/ijo.IJO_2923_20
Nimmo, A. F., Absalom, A. R., Bagshaw, O., Biswas, A., Cook, T. M., Costello, A., Grimes, S., Mulvey, D., Shinde, S., Whitehouse, T., & Wiles, M. D. (2019). Guidelines for the safe practice of total intravenous anesthesia (TIVA): Joint Guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia. Anaesthesia, 74(2), 211–224. https://doi.org/10.1111/anae.14428
Hussain, S. Y., Panjiar, P., Jain, D., Khanooja, S., & Batt, K. M. (2023). Current practice of Rapid Sequence Induction (RSI) in pediatric anesthesia: A survey from India. Journal of anaesthesiology, clinical pharmacology, 39(1), 88–97. https://doi.org/10.4103/joacp.joacp_172_21
Cardakli N, Gore RA, Kraus CL. Conversion to Glaucoma After Ocular Trauma in Pediatric Patients. Vision. 2025; 9(1):5. https://doi.org/10.3390/vision9010005
George, A., Cogliati, T., & Brooks, B. P. (2020). Genetics of syndromic ocular coloboma: CHARGE and COACH syndromes. Experimental eye research, 193, 107940. https://doi.org/10.1016/j.exer.2020.107940
Lingam, G., Sen, A.C., Lingam, V. et al. Ocular coloboma—a comprehensive review for the clinician. Eye 35, 2086–2109 (2021). https://doi.org/10.1038/s41433-021-01501-5
Chan, V., Skowno, J., A Practical Approach to Propofol-Based Total Intravenous Anesthesia (TIVA) in Children. (Nov 27, 2018) Page 1–11; https://resources.wfsahq.org/atotw/a-practical-approach-to-propofol-based-total-intravenous-anaesthesia-tiva-in-children/
Dobson, G., Chow, L., Filteau, L., Hurdle, H., McIntyre, I., Milne, A., Milkovich, R., Perrault, M. A., Sparrow, K., Swart, P. A., & Wang, Y. (2021). Guidelines to the Practice of Anesthesia - Revised Edition 2021. Guide d’exercice de l’anesthésie de la SCA – Édition révisée 2021. Canadian journal of anaesthesia = Journal canadien d'anesthesie, 68(1), 92–129. https://doi.org/10.1007/s12630-020-01842-x

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

