Ambulatory ophthalmic anesthesia: what is important

Area of Science:

• Anesthesiology
• Ophthalmology
• Geriatric Care

Background:

• Increasing numbers of adult and elderly patients are seeking ambulatory ophthalmic surgery.
• Modern surgical techniques allow for shorter hospital stays post-ophthalmic procedures.
• Caregivers require updated guidance for managing perioperative care in this growing patient population.

Purpose of the Study:

• To review key aspects of perioperative care for adult and elderly patients undergoing ambulatory ophthalmic surgery.
• To highlight updated guidelines and emerging anesthetic agents relevant to ophthalmic anesthesia.
• To provide practical recommendations for caregivers managing increased surgical case-loads.

Main Methods:

• Review of current guidelines, including 'Guidelines for the Provision of Ophthalmic Anaesthesia Services 2025' and ESAIC guidelines on postoperative delirium.
• Discussion of recent advancements in anesthetic agents, such as remimazolam.
• Synthesis of evidence regarding preoperative assessment, intraoperative management, and postoperative care.

Main Results:

• Updated guidelines emphasize streamlined preoperative assessment, especially for frail elderly patients, and removal of routine fasting for low-risk cases.
• A structured, interdisciplinary team approach is vital for managing potential complications.
• Modifiable risk factors for postoperative delirium include hemodynamic instability, inadequate analgesia, and anesthesia depth.

Conclusions:

• Patient-adapted protocols are essential for efficient perioperative management of rising ophthalmic surgery case-loads.
• Preoperative assessment should focus on identifying patients at risk for postoperative delirium, with nonpharmacological interventions to minimize incidence and duration.
• Anesthesiologists must remain vigilant for adverse events during ophthalmic anesthesia, such as retrobulbar hemorrhage and brainstem anesthesia.