Ambulatory ophthalmic anesthesia: what is important

This review addresses aspects relevant to caregivers facing increased numbers of adult and elderly patients seeking ambulatory medical service for ophthalmic surgery.

The 'Guidelines for the Provision of Ophthalmic Anaesthesia Services 2025' reinforce the importance of streamlined preoperative assessment with special consideration of frail elderly patients, removal of routine fasting for low-risk ophthalmic cases, and a structured interdisciplinary team-based approach to ensure readiness for complications. The 'Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients' stresses the importance of putative precipitating, but modifiable risk factors such as hemodynamic instability, inadequate analgesia, and depth of anesthesia. Remimazolam, a new short-acting benzodiazepine, has recently been approved for clinical use and has been investigated in endoscopic procedural sedation, among others. Studies in ophthalmic surgery patients are currently underway.

With modern surgical techniques evolving rapidly beyond cataract extraction with lens replacement, less patients require overnight hospital facilities following their ophthalmic surgeries. Implementation of rational patient-adapted protocols facilitates the perioperative management of rising case-loads. Preoperative assessment includes identifying patients at risk of postoperative delirium and initiating nonpharmacological measures to minimize its incidence and duration. After the administration of retro-, peribulbar or sub-Tenon's anesthesia, anesthesiologists must be on the alert for adverse events such as retrobulbar hemorrhage, seizures, and brainstem anesthesia.