Anesthesiologist intervention during cataract surgery under topical or peribulbar anesthesia: a propensity model...

Area of Science:

• Ophthalmology
• Anesthesiology
• Surgical Care

Background:

• Monitored anesthesia care (MAC) is increasingly utilized for cataract surgery.
• Choosing between peribulbar anesthesia (PA) and topical anesthesia (TLA) involves balancing patient comfort and anesthesiologist intervention.
• Understanding the incidence and triggers for anesthesiologist intervention is crucial for optimizing patient safety and care during MAC for cataract surgery.

Purpose of the Study:

• To compare the frequency and reasons for anesthesiologist intervention during cataract surgery performed under peribulbar anesthesia (PA) versus topical anesthesia (TLA) within a monitored anesthesia care (MAC) setting.
• To evaluate the safety and feasibility of both PA and TLA in MAC for cataract surgery.

Main Methods:

• A prospective database of phacoemulsifications was analyzed, matching 97 patients who received PA with 97 who received TLA using a propensity model.
• Patient groups were matched for relevant comorbidities and pre-operative medications including antihypertensives, cardiologic, neurologic, psychiatric history, anxiolytics, and diabetes mellitus.
• The primary outcomes measured were the incidence of anesthesiologist intervention and the types of adverse events necessitating intervention.

Main Results:

• The overall incidence of anesthesiologist intervention did not differ significantly between the peribulbar anesthesia (38.14%) and topical anesthesia (27.84%) groups (p=0.123).
• A significant difference was observed in the incidence of patient agitation, which was higher in the topical anesthesia group (9.28%) compared to the peribulbar anesthesia group (24.74%) (p=0.004).

Conclusions:

• Monitored anesthesia care is a viable option for cataract surgery using either peribulbar anesthesia or topical anesthesia.
• Peribulbar anesthesia remains a suitable alternative for patients experiencing difficulties with eye fixation, involuntary blinking, or phacodonesis.
• Clinicians should anticipate a higher likelihood of agitation with peribulbar anesthesia and consider appropriate premedication with anxiolytics when this technique is chosen.