Local anesthesia for ophthalmic surgery: patient preparation and management

Many ophthalmic procedures are performed in elderly patients who have serious concurrent disease. Local anesthesia with sedation can be a safe, advantageous method of management. Uneventful ophthalmic surgery under local anesthesia depends on proper patient selection, preparation, and perioperative management. Patients should understand the procedures and be cooperative. Preparation includes a through medical evaluation. Medical problems must be stable and appropriately managed. The goal of premedication is to have a calm, cooperative patient. Narcotic and an antiemetic sedative such as either promethazine, hydroxyzine, or droperidol should be given according to age and weight. A benzodiazepine may be added for amnesia and anxiolytic effect. Naloxone or physostigmine are available to specificity reverse the effects of narcotics or benzodiazepines, respectively. Awareness of the toxicity and limitations of local anesthetics is important for their safe use.