[Anaesthesia in cataract surgery for elderly people]

In the cataract surgery the problems of anaesthesia in ophthalmo-surgery and anaesthesia in elderly people are combined. For this patients we compared intravenous anaesthesia with balanced anaesthesia in cardiac and circulatory side effects (security), patients satisfaction and costs.

In a prospective, randomised study we compared in 52 (26 vs. 26) elderly patients (ASA II and III, mean age 78.7 +/- 8.6 years) undergoing a cataract operation cardiac and circulatory side effects, recovery time and patients satisfaction with the either type of anaesthesia by a score from 1 = best to 6 = worse and the occurrence of nausea/vomiting (controlled 24 h). The difference in costs were measured by the hospital management.

Cardiac and circulatory side effects with hypotonic reactions were similar in both groups (TIVA 18 = 69.2 %/BA 20 = 76.9 %). Hypertonic reactions were mainly seen in BA (Tiva 1.9 %, BA 69.2 %/p < 0,001). There was no problem in the treatment of these side-effects. The frequency of postoperative nausea and vomiting was lower (but not significantly) in the TIVA group (TIVA 8 %/ BA 27 %) than in the BA group (7 and 4). The recovery times were shorter (p < 0.001) in TIVA, those patients were staying 24 (+/- 6.70) minutes in the post operative unit vs. 59 (+/- 28.83) minutes in BA. Patients satisfaction was better in the TIVA-group (1.65) than in the patients treated with BA. In the calculation of costs there was a disadvantage in BA.

This study showed, that in respect of cardiac and respiratory side effects TIVA and BA are safe methods in anaesthesia for elderly people in ophthalmic surgery. Nevertheless, because of shorter recovery-times, lower incidence of hypertonic reactiones, more patients satisfaction and lower costs TIVA had better results in this study. We have to ask for the evaluation of economy in anaesthesia that not only prices of medicaments but the complete costs of the cases have to be calculated.