Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

Effect of cervical pillow in phacoemulsification surgery for age-related cataract patients: a prospective randomized controlled study

PURPOSE

To explore the application effect of cervical pillow in phacoemulsification surgery for age-related cataract patients.

METHODS

104 cases of age-related cataract patients admitted to our hospital in June 2023 were enrolled and divided into the control group (traditional supine position) and the experimental group (the cervical pillow supine position) by the digital parity method (52 cases per group). The two groups were evaluated for the discomfort score, the satisfaction of patients and doctors, the head displacement rate, the number of displacement, the operation time and the time of body position during the operation and after the operation.

RESULTS

There was no significant difference in the gender (P = 0.84), age (P = 0.86), course of disease (P = 0.82) and the time spent on position placement (P = 0.15) of the two groups. The patient in the experimental group had lower discomfort score (P = 0.0001), higher patients satisfaction (P = 0.0001) and higher doctors satisfaction (P = 0.0001) than patients in the control group. There was no significant difference between the experimental group and the control group in the proportion of intraoperative (P = 0.36) and postoperative pain (P = 0.65). Besides, the number of head transfers (P = 0.001), number of head shifts (P = 0.0001), the surgical time (P = 0.0001) and laparoscopic time (P = 0.0001) in the experimental group were significantly lower than those in the control group.

CONCLUSION

The additional cervical pillow for age-related cataract patients in the traditional supine position during the operation will not increase the preparation time before the operation, but will help improve the patient satisfaction, improve the comfort and maintain a good position of the operative eye field, bringing obvious comfort and smooth operation for the surgeon in the operation, thus reducing the risk of the operation, shortening the operation time.

Life-threatening hypotension in the immediate postoperative period of cataract surgery under topical anesthesia: a report of two cases

Background

Cataract surgery is one of the most frequent surgeries in the world. It is a very safe procedure mostly performed under topical anesthesia in outpatients centers. Due to the growing lack of anesthesiologists, cataract surgeries are more frequently performed without an anesthesiologist present in the operating room. Although extremely rare, life-threatening complications may occur.

Cases presentation

We report two cases of cataract surgery complicated by severe hypotension that required emergency resuscitation in the immediate postoperative period and hospitalization in intensive care unit. Anaphylactic shock was confirmed in the first case and suspected in the second.

Conclusions and importance

Even though cataract surgery is a very safe procedure, it is essential to ensure the presence of an anesthesiologist to manage potential, though extremely rare, life-threatening complications such as anaphylactic reactions.

Modern preoperative evaluation in ambulatory surgery - who, where and how?

PURPOSE OF REVIEW

Ambulatory surgery is increasingly performed in medically complex patients. This dynamic environment requires new approaches to ensure cost-effective, efficient, and ultimately safe preoperative evaluation of the patient. This review investigates recent advances in the assessment of ambulatory patients, with a special focus on patient screening, digital communication, and multidisciplinary team evaluation.

RECENT FINDINGS

Identifying suitable candidates for ambulatory surgery relies on a variety of medical, surgical, and institutional factors. Identification of high-risk patients and optimization of their treatment can be achieved through multidisciplinary protocols specific to the local institution and in line with current guidelines. Virtual assessment may be sufficient for most patients and provide an efficient evaluation strategy and high patient satisfaction. Prescreening can be supported by preoperative nursing teams.

SUMMARY

The increasing complexity of treatment provided in day surgery offers a unique opportunity to highlight the importance of anesthesiology staff as perioperative caregivers. Preoperative evaluation serves as a central junction to integrate a variety of surgical, medical, and institutional factors to provide safe, satisfactory, and efficient care for patients. Implementing technological innovation to streamline and facilitate this process is paramount.

Medical disease and ambulatory surgery, new insights in patient selection based on medical disease

PURPOSE OF REVIEW

Improvements in perioperative care contributed to enlarge the eligibility criteria for day case surgery and more and more patients with comorbidities may be concerned. However, underlying medical diseases may influence postoperative outcomes, and therefore, must be considered when selecting patients to undergo ambulatory surgery.

RECENT FINDINGS

To limit postoperative complications, rigid patient selection criteria are often applied in ambulatory surgery. In practice, however, most of these criteria predict the occurrence of treatable perioperative adverse events but not the need for unanticipated admission or readmission.

SUMMARY

The underlying medical diseases should not be considered as sole criteria but they should rather be regarded as a dynamic process, which includes the surgical procedure as well as the experience and expertise of the perioperative setting.