Anesthesia providers' interventions during cataract extraction under monitored anesthesia care

In 1993 Medicare paid more money to anesthesia providers for cataract surgery than for any other surgical procedure. Patients undergoing cataract surgery often receive monitored anesthesia care (MAC). Thus, cuts in anesthesia payments from Medicare for cataract surgery may be forthcoming. If few interventions were being done after a retrobulbar block was placed, then a registered nurse might be a safe alternative to an anesthesia provider to monitor the patient. The goal of this study was to describe interventions of anesthesia providers during cataract extraction after the placement of a retrobulbar block. Anesthetic records were reviewed for 560 consecutive cases of cataract extraction using MAC at a large tertiary medical center. Anesthesia providers performed interventions (e.g., administration of drugs) on 33% of patients after the retrobulbar block was in place (95% confidence bound, < 36%). In conclusion, insufficient evidence exists for managed care organizations or other groups to justify a change in practice toward a registered nurse monitoring patients undergoing cataract extraction with a retrobulbar block. Furthermore, until a prospective randomized study has been done, such organizations lack justification for decreasing the amount of time that anesthesia providers spend caring for such patients undergoing cataract extraction.