Structured assessment tool to evaluate patient suitability for cataract surgery under local anaesthesia

Preoperative Care for Cataract Surgery: The Society for Ambulatory Anesthesia Position Statement

Cataract surgeries are among the most common procedures requiring anesthesia care. Cataracts are a common cause of blindness. Surgery remains the only effective treatment of cataracts. Patients are often elderly with comorbidities. Most cataracts can be treated using topical or regional anesthesia with minimum or no sedation. There is minimal risk of adverse outcomes. There is general consensus that cataract surgery is extremely low risk, and the benefits of sight restoration and preservation are enormous. We present the Society for Ambulatory Anesthesia (SAMBA) position statement for preoperative care for cataract surgery.

Preoperative Evaluation for Ambulatory Anesthesia: What, When, and How?

Most surgery in the United States occurs in offices, free-standing surgicenters, and hospital-based outpatient facilities. Patients are frequently elderly with comorbidities, and procedures are increasingly complex. Traditionally, patients have been evaluated on the day of surgery by anesthesia providers. Obtaining information on patients' health histories, establishing criteria for appropriateness, and communicating medication instructions streamline throughput, lower cancellations and delays, and improve provider and patient satisfaction. Routine testing does not lower risk or improve outcomes. Evaluating and optimizing patients with significant diseases, especially those with suboptimal management, has positive impact on ambulatory surgery and anesthesia.

Cataract surgery anaesthesia: is topical anaesthesia really better than retrobulbar?

PURPOSE

To compare the effectiveness for the patient of retrobulbar anaesthesia (RBA) and topical anaesthesia (TA) in cataract surgery by phacoemulsification.

METHODS

We performed a prospective, randomized study on 115 patients operated at our clinic using the two anaesthesia techniques. The RBA group comprised 57 patients (20 women, 37 men; age 72 +/- 10 years); the TA group comprised 58 patients (20 women, 38 men; age 74 +/- 10 years). Measured parameters were: blood pressure; heart rate; blood oxygen saturation level; serum adrenaline, noradrenaline and cortisol levels; white blood cell count; indicated pain during the procedure, and pain as reported by the patient afterwards. Two psychological tests were used: the State-Trait Anxiety Inventory (STAI), and the patient-selected face-scale test. Statistical analysis was performed using Student's t-test and the chi-square test. Results were also analysed using a logistic regression model.

RESULTS

Both types of anaesthesia were adequate for the surgical procedure. In the RBA group fewer patients experienced pain during surgery (p < 0.01) and fewer recalled any perioperative discomfort. With RBA the objective parameters were more stable than with TA, and systolic blood pressure was significantly lower (p = 0.01). The logistic model was able to predict perioperative pain with 93% certainty. Pain sensitivity was higher in younger patients and in patients with higher initial cortisol and noradrenaline serum levels.

CONCLUSIONS

Both methods of anaesthesia are appropriate, but phacoemulsification with TA is more painful than with RBA. In hypertonic patients and younger patients who are more susceptible to pain, TA should be avoided or used in combination with individualized sedation.