[Frequency of intervention and risk factors in monitored anesthesia care in ophthalmic surgery -- a retrospective...

Patients for ophthalmic surgery have an average age of 70 - 75 years and frequently suffer from cardiopulmonary disease. Despite the fact that only local anesthesia is applied, these patients often receive monitored anesthesia care. Aims of this study were to determine the frequency of drug interventions during monitored anesthesia care and to identify risk factors for treatment.

In a retrospective study, preoperative history and anaesthetic records of 404 patients who had received monitored anesthesia care in a university hospital were analyzed for patient data, preoperative diagnoses and intraoperative anesthesiological interventions.

Patients were 70 +/- 12 years old and had a high co-morbidity (63 % ASA-classification 3), especially an increased cardiopulmonary risk. 50 % of all patients received a drug intervention. 41 % were given an antihypertonic agent intraoperatively and 17 % received other forms of drug treatment (e. g. insulin therapy, infusion of electrolytes, antiemetics). In 2,5 % of the cases severe cardiovascular complications occurred which needed treatment (severe arrhythmias, hypertensive crisis, severe hypotension with need for catecholamine therapy). The two parameters "arterial hypertension" (54 % intervention frequency vs. 35 % without arterial hypertension) and the surgical procedure of "pars plana vitrectomy" (58 % intervention frequency vs. 41 % for cataract surgery) were associated with a significantly increased frequency for intraoperative interventions.

The high intervention frequency for a variety of complications, especially of cardiovascular nature, advises the presence of a physician during ophthalmic operations who is trained to control such emergency situations.