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Shapiro JN, Mian SI. Nontraditional approaches to sedation for anterior segment surgery: a narrative review. Curr Opin Ophthalmol 2024; 35:298-303. [PMID: 38704652 DOI: 10.1097/icu.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
PURPOSE OF REVIEW Surgical and anesthetic technological advancement have made both cataract and noncataract anterior segment surgery significantly less invasive and time-intensive, facilitating the transition of some of these procedures from the operating room under monitored anesthesia care (MAC) to the office-based setting without MAC. This transition has been aided by the popularization of nonintravenous approaches to achieving patient sedation for these procedures. In this review, we discuss the literature surrounding traditional and nontraditional methods of achieving patient sedation for anterior segment surgery. RECENT FINDINGS Our survey of the literature suggests that nonintravenous (IV) approaches to sedation for these procedures may be just as safe, effective, and satisfactory to patients as traditional IV approaches. SUMMARY As anterior segment surgery becomes less invasive and less time-intensive, providers considering transitioning their cataract and anterior segment surgery out of the operating room and into the office-based setting without MAC anesthesia should consider the non-IV sedation options outlined in this review to achieve adequate patient sedation and comfort.
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Affiliation(s)
- Jeremy N Shapiro
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Shahzad I Mian
- Department of Ophthalmology and Visual Sciences, University of Michigan Kellogg Eye Center
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2
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Qian T, Gong Q, Shu Y, Shen H, Wu X, Wang W, Zhang Z, Cao H, Xu X. The Efficacy and Safety of Diazepam for Intraoperative Blood Pressure Stabilization in Hypertensive Patients Undergoing Vitrectomy Under Nerve Block Anesthesia: A Prospective, Single-Center, Double-Blind, Randomized, Controlled Trial. Ther Clin Risk Manag 2024; 20:9-18. [PMID: 38230372 PMCID: PMC10790667 DOI: 10.2147/tcrm.s441152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose To evaluate the effectiveness and safety of diazepam in maintaining stable intraoperative blood pressure (BP) in hypertensive patients undergoing vitrectomy under nerve block anesthesia. Methods A total of 180 hypertensive patients undergoing vitrectomy with nerve block anesthesia were randomized into two groups. The intervention group was given oral diazepam 60 min before operation, while the control group was given oral placebo 60 min before operation. The primary outcome is the effective rate of intraoperative BP control, defined as systolic blood pressure (SBP) during the operation maintained < 160 mmHg at all timepoints. The logistic regression model will be performed to analyze the compare risk factors for ineffective BP control. Results The effective rate of intraoperative SBP control in the diazepam group was significant higher than that in the placebo group from 15 min to 70 min of the surgery (P < 0.05). The proportion of patients with SBP ≥180 mmHg at any timepoint from operation to 1 h postoperation was higher in the placebo group (12.22%) than in the diazepam group (2.22%) (P = 0.0096). We observed that the change in SBP from baseline consistently remained higher in the placebo group than in the diazepam group. In the logistic regression analysis, age, years of diagnosed hypertension and SBP 1h before surgery were significant risk factors for ineffective BP control. Conclusion This study provides robust evidence supporting the effectiveness of oral diazepam as a pre-surgery intervention in maintaining stable blood pressure during vitrectomy in hypertensive patients. Trial Registration Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100041772.
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Affiliation(s)
- Tianwei Qian
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Qiaoyun Gong
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Yiyang Shu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Hangqi Shen
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Xia Wu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Weijun Wang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Zhihua Zhang
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Hui Cao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- National Clinical Research Center for Eye Diseases, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, People’s Republic of China
- Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Disease, Shanghai, People’s Republic of China
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Irawati D, Adli M, Yadi DF. Successful Use of Low-Dose Combination Propofol and Fentanyl in Cataract Surgery Phacoemulsification. Clin Ophthalmol 2023; 17:1929-1937. [PMID: 37431431 PMCID: PMC10329823 DOI: 10.2147/opth.s415852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
Background The combination between sedatives and opioids is one of the recommended anesthetic options in ophthalmic procedures and regimens are more advantageous as smaller amounts of each drug can be administered to reduce side effects and have proper outcomes due to the synergistic effects. This study aims to observe the use of low-dose propofol and fentanyl for patients undergoing phacoemulsification surgery. Material and Methods This observational study involves a sample of 125 adult patients who underwent elective cataract procedures using the phacoemulsification technique and had an American Society of Anesthesiologists (ASA) physical status of 1 to 3. Dose amount of fentanyl and propofol, Ramsay score, hemodynamic parameter, side effects, and patient satisfaction were evaluated, recorded, and analyzed using a 5-point Likert scale. Results The result showed the mean absolute dose of propofol was 12.46±4.376 mg, with a range between 10 and 30 mg, while the mean per body weight was 0.21±0.075 mg. Similarly, the mean absolute dose for fentanyl was 25.04±3.012 mcg within the range of 10-50 mcg, and the per-body weight dose was 0.43±0.080 mcg. About 90.4% and 9.6% of the patients reached Ramsay 2 and 3, respectively. The analysis of systolic, diastolic blood pressure, mean arterial pressure, and pulse rate showed that the combination of low-dose fentanyl and propofol was significantly lower than before therapy administration in all four values (p < 0.05). Conclusion The combination of low-dose propofol and fentanyl in cataract surgery using phacoemulsification successfully reached the targeted sedation level and a significant decrease in blood pressure, MAP, pulse rate, minimal side effects, and high satisfaction rate.
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Affiliation(s)
- Dian Irawati
- Department of Anesthesiology, National Eye Center Cicendo Eye Hospital-Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Muhamad Adli
- Department of Anesthesiology, National Eye Center Cicendo Eye Hospital-Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Dedi Fitri Yadi
- Department of Anesthesiology, Dr. Hasan Sadikin General Hospital- Universitas Padjadjaran, Bandung, West Java, Indonesia
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Ahmed M, Krishna Y, Popova P, Herbert R, Sidaras G, Choudhary A, Kaye SB. Low-Dose Propofol with Peribulbar Anaesthesia for Cataract Surgery. J Clin Med 2023; 12:jcm12072742. [PMID: 37048825 PMCID: PMC10095169 DOI: 10.3390/jcm12072742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/07/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023] Open
Abstract
In this paper, we investigate the effect of sedation using low-dose propofol on patient reported outcome measures (PROMS) in patients undergoing cataract surgery. This is a randomised, single-blinded observational prospective study. Patients undergoing elective cataract surgery using peribulbar anaesthesia over consecutive cataract lists were selected for this trial. Patients were randomised to receive either no sedation or low-dose propofol (20 to 30 mg followed by 10 mg increments until the patient developed slurred speech alone) prior to the administration of local anaesthesia. Pain, satisfaction, anxiety, needle recall, pulse, and blood pressure (BP) were measured. A total of 97 patients were included, 50 of whom received propofol. There were 4 senior surgeons and anaesthetists. There were no ocular or systemic complications and all patients had uncomplicated surgery. Anxiety (p = 0.026), needle recall (p < 0.001), difference in systolic BP (p = 0.043), and pulse (p = 0.046) were dependent on patient age (p < 0.001) and the use of propofol (p = 0.007). Lower pain was associated with propofol (p = 0.008), as well as lower anxiety (p = 0.002), and increased patient age (p = 0.014). The administration of propofol was significantly associated with lower needle recall (p < 0.001), pre- to post-operative difference in systolic BP (p = 0.029), and mean BP (p = 0.044). Low-dose propofol given immediately prior to administration of local anaesthesia was associated with reduced pain and needle recall, as well as lower BP.
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Affiliation(s)
- Mahmoud Ahmed
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Yamini Krishna
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Petya Popova
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Rose Herbert
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Gediminas Sidaras
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Anshoo Choudhary
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Stephen B Kaye
- St Paul's Eye Unit, Department of Ophthalmology, The Royal Liverpool University Hospital, Liverpool L7 8XP, UK
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Kumar C, Seet E, Chua A. Updates in ophthalmic anaesthesia in adults. BJA Educ 2023; 23:153-159. [PMID: 36960436 PMCID: PMC10028395 DOI: 10.1016/j.bjae.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- C.M. Kumar
- Khoo Teck Puat Hospital, Yishun, Singapore
- Newcastle University Medical School, EduCity, Johor, Malaysia
| | - E. Seet
- Khoo Teck Puat Hospital, Yishun, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - A.W.Y. Chua
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Korkmaz S, Kaderli A, Kaderli ST, Sul S, Karalezli A. Using Alprazolam before phacoemulsification cataract surgery reduces complications and duration of the surgery. Int Ophthalmol 2023:10.1007/s10792-023-02657-7. [PMID: 36877317 DOI: 10.1007/s10792-023-02657-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Abstract
PURPOSE To evaluate the effect of preoperative Alprazolam on complications of phacoemulsification cataract surgery, duration of surgery and early reoperation rate. METHODS Records of 1026 eyes of 1026 consecutive patients underwent phacoemulsification with topical and intracameral anesthesia between 2016 and 2020 years were retrospectively reviewed. Patients were divided into two groups, with or without using Alprazolam before surgery. Patients with planned first-time surgery for senile cataract and at least three months follow-up postoperatively were included. Those who had pseudoexfoliation, small pupil, zonular weakness, corneal and hearing problem as well as traumatic, brown, mature, hypermature, and posterior polar cataracts were excluded. Main outcome measures were duration of surgery, posterior capsule rupture, rapid posterior capsule opacification (PCO) formation requiring the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser and reoperation rate in early postoperative periods. RESULTS Alprazolam and control groups included 490 and 536 eyes, respectively. Mean surgical time was shorter in Alprazolam group (10.2 ± 3 versus 12.2 ± 4 min; < 0.001). Rate of posterior capsule rupture was higher in control group (4 versus 15 eyes; = 0.02). Four eyes (0.8%) in control group underwent unplanned secondary surgical procedures in early postoperative period (P = 0.126). Rate of rapid PCO formation was higher in control group (1 versus 9 eyes; = 0.027). CONCLUSIONS Using Alprazolam before phacoemulsification can lead to less posterior capsule rupture, short operation time and prevent repetitive surgery. It also reduces rapid PCO formation and, thus, early Nd:YAG laser intervention due to better cleaning the posterior capsule during surgery. We conclude that Alprazolam not only reduces intraoperative complications, but also facilitates their management.
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Affiliation(s)
- Safak Korkmaz
- Ophthalmology, Faculty of Medicine, Giresun University, Giresun, Turkey.
| | - Ahmet Kaderli
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Sema Tamer Kaderli
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Sabahattin Sul
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
| | - Aylin Karalezli
- Ophthalmology, Faculty of Medicine, Mugla Sıtkı Kocman University, Mugla, Turkey
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Nguyen XTA, Thiadens AAHJ, Fiocco M, Tan W, McKibbin M, Klaver CCW, Meester-Smoor MA, Van Cauwenbergh C, Strubbe I, Vergaro A, Pott JWR, Hoyng CB, Leroy BP, Zemaitiene R, Khan KN, Boon CJF. Outcome of Cataract Surgery in Patients With Retinitis Pigmentosa. Am J Ophthalmol 2023; 246:1-9. [PMID: 36252678 DOI: 10.1016/j.ajo.2022.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/02/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To assess the visual outcome of cataract surgery in patients with retinitis pigmentosa (RP). DESIGN Retrospective, noncomparative clinical study. METHODS Preoperative, intraoperative, and postoperative data of patients with RP who were undergoing cataract surgery were collected from several expertise centers across Europe. RESULTS In total, 295 eyes of 226 patients were included in the study. The mean age at surgery of the first eye was 56.1 ± 17.9 years. Following surgery, best-corrected visual acuity (BCVA) improved significantly from 1.03 to 0.81 logMAR (ie, 20/214 to 20/129 Snellen) in the first treated eye (-0.22 logMAR; 95% CI = -0.31 to -0.13; P < .001) and from 0.80 to 0.56 logMAR (ie, 20/126 to 20/73 Snellen) in the second treated eye (-0.24 logMAR; 95% CI = -0.32 to -0.15; P < .001). Marked BCVA improvements (postoperative change in BCVA of ≥0.3 logMAR) were observed in 87 of 226 patients (39%). Greater odds for marked visual improvements were observed in patients with moderate visual impairment or worse. The most common complications were zonular dialysis (n = 15; 5%) and (exacerbation of) cystoid macular edema (n = 14; 5%), respectively. Postoperative posterior capsular opacifications were present in 111 of 295 eyes (38%). CONCLUSION Significant improvements in BCVA are observed in most patients with RP following cataract surgery. Baseline BCVA is a predictor of visual outcome. Preoperative evaluation should include the assessment of potential zonular insufficiency and the presence of CME, as they are relatively common and may increase the risk of complications.
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Affiliation(s)
- Xuan-Thanh-An Nguyen
- From the Department of Ophthalmology (X.N., C.J.F.B.), Leiden University Medical Center, Leiden, Netherlands
| | - Alberta A H J Thiadens
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands
| | - Marta Fiocco
- Mathematical Institute (M.F.), Leiden University, Leiden, the Netherlands; Department of Biomedical Data Sciences (M.F.), Leiden University Medical Center, Leiden, Netherlands
| | - Weijen Tan
- Department of Ophthalmology (W.T., M.M.), Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Martin McKibbin
- Department of Ophthalmology (W.T., M.M.), Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Caroline C W Klaver
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology (C.C.W.K., M.A.M.), Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, Netherlands; Institute of Molecular and Clinical Ophthalmology (C.C.W.K.), University of Basel, Basel, Switzerland
| | - Magda A Meester-Smoor
- Department of Ophthalmology (A.A.H.J.T., C.C.W.K., M.A.M.), Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology (C.C.W.K., M.A.M.), Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Caroline Van Cauwenbergh
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics (C.V., B.P.L.), Ghent University and Ghent University Hospital, Ghent, Belgium
| | - Ine Strubbe
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium
| | - Andrea Vergaro
- Department of Pediatrics and Inherited Metabolic Disorders (A.V.), Charles University and General University Hospital, Prague, Czech Republic
| | - Jan-Willem R Pott
- Department of Ophthalmology (J.R.P.), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Carel B Hoyng
- Department of Ophthalmology (C.C.W.K., C.B.H.), Radboud University Medical Center, Nijmegen, Netherlands
| | - Bart P Leroy
- Department of Ophthalmology, Ghent (C.V., I.S., B.P.L.) University and Ghent University Hospital, Ghent, Belgium; Center for Medical Genetics (C.V., B.P.L.), Ghent University and Ghent University Hospital, Ghent, Belgium; Division of Ophthalmology (B.P.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Centre for Cellular & Molecular Therapeutics (B.P.L.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Reda Zemaitiene
- Department of Ophthalmology (R.Z.), Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kamron N Khan
- Novartis Institute of BioMedical Research (K.N.K.), Cambridge, Massachusetts, USA; Department of Ophthalmology (K.N.K.), Harvard Medical School, Boston, Massachusetts, USA
| | - Camiel J F Boon
- From the Department of Ophthalmology (X.N., C.J.F.B.), Leiden University Medical Center, Leiden, Netherlands; Department of Ophthalmology (C.J.F.B.), Amsterdam University Medical Centers, Amsterdam, Netherlands.
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Clinical Ocular Exposure Extrapolation for Ophthalmic Solutions Using PBPK Modeling and Simulation. Pharm Res 2023; 40:431-447. [PMID: 36151444 PMCID: PMC9944674 DOI: 10.1007/s11095-022-03390-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The development of generic ophthalmic drug products is challenging due to the complexity of the ocular system, and a lack of sensitive testing to evaluate the interplay of physiology with ophthalmic formulations. While measurements of drug concentration at the site of action in humans are typically sparse, these measurements are more easily obtained in rabbits. The purpose of this study is to demonstrate the utility of an ocular physiologically based pharmacokinetic (PBPK) model for translation of ocular exposure from rabbit to human. METHOD The Ocular Compartmental Absorption and Transit (OCAT™) model within GastroPlus® v9.8.2 was used to build PBPK models for levofloxacin (Lev), moxifloxacin (Mox), and gatifloxacin (Gat) ophthalmic solutions. in the rabbit eye. The models were subsequently used to predict Lev, Mox, and Gat exposure after ocular solution administrations in humans. Drug-specific parameters were used as fitted and validated in the rabbit OCAT model. The physiological parameters were scaled to match human ocular physiology. RESULTS OCAT model simulations for rabbit well described the observed concentrations in the eye compartments following Lev, Mox, and Gat solution administrations of different doses and various administration schedules. The clinical ocular exposure following ocular administration of Lev, Mox, and Gat solutions at different doses and various administration schedules was well predicted. CONCLUSION Even though additional case studies for different types of active pharmaceutical ingredients (APIs) and formulations will be needed, the current study represents an important step in the validation of the extrapolation method to predict human ocular exposure for ophthalmic drug products using PBPK models.
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Davidson RS, Donaldson K, Jeffries M, Khandelwal S, Raizman M, Rodriguez Torres Y, Kim T. Persistent opioid use in cataract surgery pain management and the role of nonopioid alternatives. J Cataract Refract Surg 2022; 48:730-740. [PMID: 34753878 PMCID: PMC9119400 DOI: 10.1097/j.jcrs.0000000000000860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022]
Abstract
Cataracts are a leading cause of preventable blindness globally. Although care varies between developing and industrialized countries, surgery is the single effective approach to treating cataracts. From the earliest documented primitive cataract removals to today's advanced techniques, cataract surgery has evolved dramatically. As surgical techniques have developed, so have approaches to surgical pain management. With current cataract surgical procedures and advanced technology, anesthesia and intraoperative pain management have shifted to topical/intracameral anesthetics, with or without low-dose systemic analgesia and anxiolysis. Despite this, pain and discomfort persist in some patients and are underappreciated in modern cataract surgery. Although pain management has progressed, opioids remain a mainstay intraoperatively and, to a lesser extent, postoperatively. This article discusses the evolution of pain management in cataract surgery, particularly the use of opioids and the associated risks as well as how ophthalmology can have a positive impact on the opioid crisis.
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Affiliation(s)
- Richard S. Davidson
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Kendall Donaldson
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Maggie Jeffries
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Sumitra Khandelwal
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Michael Raizman
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Yasaira Rodriguez Torres
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
| | - Terry Kim
- From the University of Colorado Eye Center, Denver, Colorado (Davidson); the Bascom Palmer Eye Institute, Plantation, Florida (Donaldson); the Houston Eye Associates, Houston, Texas (Jeffries); the Eye Center of Texas, Houston, Texas (Jeffries); the Baylor College of Medicine, Cullen Eye Institute, Houston, Texas (Khandelwal); the Tufts University School of Medicine, New England Eye Center, Boston, Massachusetts (Raizman); the Kresge Eye Institute, Detroit, Michigan (Rodriguez Torres); the Elmquist Eye Group, Fort Myers, Florida (Rodriguez Torres); the Duke Eye Center, Duke University, Durham, North Carolina (Kim)
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10
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Hock LE, Kennedy S, Wilson CW, Polking A, Portwood J, Oetting T, Terveen D. Oral anxiolytics prior to routine resident cataract surgery eliminate need for intravenous sedation at a Veterans Affairs Hospital. Am J Ophthalmol Case Rep 2022; 25:101379. [PMID: 35198808 PMCID: PMC8842029 DOI: 10.1016/j.ajoc.2022.101379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 08/17/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the frequency of intraoperative intravenous sedation administration during routine resident-performed cataract surgery among patients receiving pre-operative oral sedation at a Veterans Affairs Medical Center and its impact on patient safety and system cost. Methods Retrospective review of all resident-performed cataract surgeries performed at the Iowa City Veterans Affairs Medical Center in 2013 and 2017. Cases monitored by a registered nurse were included. Combined cases and cases monitored by an anesthesia provider were excluded. Pre-operative placement of an intravenous (IV) catheter, administration of intra-operative IV sedation, oral diazepam administration, anesthesia type, conditions for administering intraoperative IV medication, and cost of IV catheter placement were recorded. Results Of 1025 patient cases included for analysis, 972 received pre-operative diazepam (94.9%) and 1017 (99.3%) had IV catheters placed. One patient received a planned dose of IV methylprednisolone. Zero patients received supplemental intraoperative IV sedation. The estimated materials cost of unused IV catheters was $10,668 over 2 years. Conclusions Pre-operative IV catheter placement may not be necessary in patients undergoing routine resident cataract surgery with pre-operative oral sedation. Discontinuation of routine IV placement may improve patient satisfaction and decrease health care costs without compromising patient safety.
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Affiliation(s)
- Lauren E Hock
- University of Iowa Hospital and Clinics, Department of Ophthalmology and Visual Sciences, Iowa City, IA, USA.,Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Sean Kennedy
- University of Iowa Hospital and Clinics, Department of Ophthalmology and Visual Sciences, Iowa City, IA, USA
| | - Caroline W Wilson
- University of Iowa Hospital and Clinics, Department of Ophthalmology and Visual Sciences, Iowa City, IA, USA.,Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Ann Polking
- Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
| | | | - Thomas Oetting
- University of Iowa Hospital and Clinics, Department of Ophthalmology and Visual Sciences, Iowa City, IA, USA.,Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
| | - Daniel Terveen
- University of Iowa Hospital and Clinics, Department of Ophthalmology and Visual Sciences, Iowa City, IA, USA.,Iowa City Veterans Affairs Medical Center, Iowa City, IA, USA
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11
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Kumar CM, Vohra SB, Farahmand Rad R. Vitreoretinal Surgery Under Sub-Tenon’s Block and Conscious Sedation in a Patient with Brugada Syndrome: A Case Report and Literature Review. Anesth Pain Med 2021; 11:e120217. [PMID: 35075419 PMCID: PMC8782191 DOI: 10.5812/aapm.120217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022] Open
Abstract
Brugada syndrome (BrS), a type of sudden arrhythmic unexpected death syndrome (SADS), is characterized by specific electrocardiogram (ECG) changes, a structurally normal heart, and susceptibility to life-threatening ventricular arrhythmias. General anesthesia (GA) is usually used for major surgery in patients with BrS due to concerns that some local anesthetic agents may precipitate critical arrhythmias. The majority of ophthalmic surgeries are successfully carried out under regional anesthesia (RA). The literature does not address the use of ophthalmic RA in patients with BrS except one report of peribulbar block for glaucoma surgery. This clinical case report and the liertature review suggests that for BrS patients presenting for vitreoretinal surgery, a sub-tenon block, with or without sedation may safely be used as a primary anaethestic technique.
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Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
- Corresponding Author: : Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore.
| | - Shashi B Vohra
- Department of Anaesthesia, Critical Care and Pain Management, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Reza Farahmand Rad
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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12
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Venkatesh R, Kenia H, Sengupta S, Gopalakrishna M, Au Eong KG. Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: A randomized controlled trial. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100006. [PMID: 37846396 PMCID: PMC10577815 DOI: 10.1016/j.aopr.2021.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/19/2021] [Accepted: 09/05/2021] [Indexed: 10/18/2023]
Abstract
Purpose Effect of intravenous sedation on patients' visual experience and vital signs during cataract surgery under topical anesthesia: a randomized controlled trial. Design Prospective, double masked, randomized controlled trial. Methods 150 eyes of 150 patients undergoing phacoemulsification and IOL implantation under topical anesthesia were randomized to receive either intravenous midazolam (0.015 mg/kg) or normal saline. The patients' experience was evaluated using a questionnaire. Vital signs including blood pressure and heart rate were measured before, during and after surgery. Mean arterial pressure (MAP) was calculated. Results Both groups were comparable except that fewer patients in the control group were pseudophakic in the fellow eye (25.3% vs. 41.3%). More patients in the control group perceived hand movements (p < 0.01), surgeon/medical staff (p = 0.04) and sudden increase in vision during surgery (p < 0.01) compared to midazolam group. More control group patients experienced fear (p < 0.001), pain (p = 0.06) and unpleasant surgical experience (20.3% vs. 1.3%, p < 0.001). They also experienced greater fluctuation in MAP (16.9 ± 7.9 vs.7.2 ± 5.3, p < 0.001) and this was accentuated in hypertensives. After adjusting for age, gender, hypertension status and other eye lens status, multivariable logistic regression analysis revealed that subjects in the control arm (OR = 11.7, 95% [CI] = 1.3-108, p = 0.03), had a longer duration of surgery, experienced pain and more likely to report unpleasant experience. Adjusting for similar covariates, multivariable linear regression analysis showed that control group patients (β = 8.5 mmHg, 95% CI = 6.2-10.8, p = 0.03) had hypertension, experienced fear during surgery and greater fluctuations in the MAP. Conclusions A sedative dose of intravenous midazolam during phacoemulsification under topical anesthesia significantly reduces patients' visual experience, fear and fluctuations in MAP and improves overall surgical experience.
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Affiliation(s)
| | | | | | | | - Kah-Guan Au Eong
- International Eye Cataract Retina Center, Mount Elizabeth Medical Center and Farrer Park Medical Center, Singapore
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13
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Kumar CM, Chua AWY, Imani F, Sehat-Kashani S. Practical Considerations for Dexmedetomidine Sedation in Adult Cataract Surgery Under Local/Regional Anesthesia: A Narrative Review. Anesth Pain Med 2021; 11:e118271. [PMID: 34692445 PMCID: PMC8520679 DOI: 10.5812/aapm.118271] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/26/2021] [Indexed: 01/28/2023] Open
Abstract
Cataract surgery is predominantly performed under local/regional anesthesia, with or without sedation. The practice pattern of sedation is unknown and seems to vary significantly among institutions and countries, routinely administered in some parts of the world to the other extreme of none at all. The selection of sedative agents and techniques varies widely. Currently, there is no ideal sedative agent. Dexmedetomidine has gained recent attention for sedation in ophthalmic local/regional anesthesia due to its alleged advantages of effective sedation with minimal respiratory depression, decreased intraocular pressure, and reduced pain during the local anesthetic injection; however, they are subject to differing interpretations. Published literature also suggests that although dexmedetomidine sedation for cataract surgery under local/regional anesthesia is potentially useful, its role may be limited due to logistical difficulties in administering the recommended dose.
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Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Alfred W. Y. Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Saloome Sehat-Kashani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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14
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Obuchowska I, Konopinska J. Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review. Psychol Res Behav Manag 2021; 14:781-793. [PMID: 34177276 PMCID: PMC8219311 DOI: 10.2147/prbm.s314214] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Cataract surgery is one of the most frequently performed surgical procedures worldwide. Patients usually experience strong negative emotions, such as fear and anxiety. A systematic review of the recent literature regarding the emotional states experienced during cataract surgery under local anaesthesia was performed based on the PubMed and Scopus databases. The objective of this review was to determine the causes and frequency of fear and anxiety, as well as methods for improving intraoperative experience and supporting the patient prior to surgery. Anxiety is mainly caused by fear of the surgery itself, fright of pain, and loss of vision. Abstaining and visual sensations experienced during cataract surgery also increased the preoperative anxiety. Women and hypochondriacs showed higher levels of anxiety. The greatest intensity of negative emotions occurred on the day of the cataract surgery. Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. In order to reduce patients’ negative experiences, pharmacological sedation, preoperative education and counselling, manual massage immediately before surgery, and listening to music during surgery are used. Taking this information into consideration allows the introduction of effective methods of eliminating the patient’s negative feelings in connection with cataract surgery, which leads to an improvement in the results of the operation and an increase in the patients’ sense of satisfaction and quality of life.
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Affiliation(s)
- Iwona Obuchowska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
| | - Joanna Konopinska
- Department of Ophthalmology, Medical University of Bialystok, Bialystok, Poland
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15
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Bigoteau M, Grammatico-Guillon L, Massot M, Baudet JM, Duroi Q, Pichard T, Slim M, Pisella PJ, Khanna RK. [Clinical and economic impact of an ambulatory cataract surgery center without anesthesia in an area with poor ophthalmologic coverage]. J Fr Ophtalmol 2021; 44:947-956. [PMID: 34148703 DOI: 10.1016/j.jfo.2020.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Ambulatory Clinic for Cataract Surgery (CACC) is a public department of the Bourges Medical Center, with a fast-track protocol without perioperative anesthesia care launched in 2015. This study aimed to evaluate the benefits of the CACC in terms of access to cataract surgery. METHODS This retrospective study included all patients undergoing cataract surgery between 2012 and 2018. Data were collected from the French PMSI database. In order to evaluate the impact of the CACC, the surgical activity and change in indicators of patient flow and usage, as well as clinical and economic factors were analyzed. RESULTS Between 2012 and 2018, with the same number of ophthalmologists, surgical activity increased by 50.2% in the Cher (vs. a mean increase of 22.7% in France). The patient loss ratio decreased by 5.9 points, the attraction and self-sufficiency ratios increased by 2.3 and 8.6 points respectively. The standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (from 11.6 to 15.9 surgeries per 1000 inhabitants). As a result, Cher became the second highest French Department in 2018 in terms of utilization rate despite its 96th place out of 109 Departments in terms of density of ophthalmologists. CONCLUSION The ambulatory cataract surgery center without anesthesia for selected patients might represent a solution in medical deserts to improve access to cataract surgery without increasing costs.
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Affiliation(s)
- M Bigoteau
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France; Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - L Grammatico-Guillon
- Service de santé publique, faculté de médecine de Tours, unité d'épidémiologie EpiDcliC, université de Tours, CHRU de Tours, France
| | - M Massot
- Département d'information médicale, centre hospitalier Jacques Cœur, Bourges, France
| | - J-M Baudet
- Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - Q Duroi
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France
| | - T Pichard
- Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - M Slim
- Service d'ophtalmologie, Centre Hospitalier Jacques Cœur, Bourges, France
| | - P-J Pisella
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France
| | - R K Khanna
- Service d'ophtalmologie, centre hospitalier universitaire régional de Bretonneau, Tours, France.
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16
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Kumar CM, Palte HD, Chua AWY, Sinha R, Shah SB, Imani F, Jalali ZM. Anesthesia Considerations for Cataract Surgery in Patients with Schizophrenia: A Narrative Review. Anesth Pain Med 2021; 11:e113750. [PMID: 34336627 PMCID: PMC8314087 DOI: 10.5812/aapm.113750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022] Open
Abstract
Schizophrenia is ranked among the top 10 global burdens of disease. About 1% of people meet the diagnostic criteria for this disorder over their lifetime. Schizophrenic patients can develop cataract, particularly related to age and medications, requiring surgery and anesthesia. Many concerning factors, including cognitive function, anxiety, behavioral issues, poor cooperation and paroxysmal movements, may lead to general anesthesia as the default method. Antipsychotic agents should be continued during the perioperative period if possible. Topical/regional anesthesia is suitable in most schizophrenic patients undergoing cataract surgery. It reduces potential drug interactions and many postoperative complications; however, appropriate patient selection is paramount to its success. General anesthesia remains the primary technique for patients who are considered unsuitable for the topical/regional technique. Early involvement of a psychiatrist in the perioperative period, especially for patients requiring general anesthesia, is beneficial but often under-utilized. This narrative review summarizes the anesthetic considerations for cataract surgery in patients with schizophrenia.
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Affiliation(s)
- Chandra M. Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore
- Newcastle University Medical School, Johor, Malaysia
- Corresponding Author: Department of Anaesthesia, Khoo Teck Puat Hospital, Yishun, Singapore.
| | - Howard D. Palte
- Department of Anaesthesia, Bascom Palmer Eye Institute, University of Miami, Miami, USA
| | - Alfred W. Y. Chua
- Department of Anaesthesia, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Renu Sinha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Shreya B. Shah
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Farnad Imani
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra M. Jalali
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
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17
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Bigoteau M, Grammatico-Guillon L, Massot M, Baudet JM, Cook AR, Duroi Q, Pichard T, Slim M, Pisella PJ, Khanna RK. Ambulatory surgery centers: possible solution to improve cataract healthcare in medical deserts. J Cataract Refract Surg 2021; 47:352-357. [PMID: 33086293 DOI: 10.1097/j.jcrs.0000000000000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate the epidemiological impact of an ambulatory cataract surgery center providing a fast-track procedure without anesthetic evaluation on the access to cataract healthcare. SETTING French nationwide study. DESIGN Retrospective cross-sectional study. METHODS The study included individuals undergoing cataract surgery from the French national administrative database of medical information. Data analyses focused on patients living in the Cher and neighboring areas. Epidemiological indicators of patient flow and healthcare efficiency were calculated. A medicoeconomic analysis was performed. RESULTS Between 2012 and 2018, activity increased by +50.2% (3665 to 5506) interventions in the Cher area compared with a national increase of +22.7% (720 351/884 254), while maintaining a constant ophthalmologist workforce. The leakage ratio decreased by 5.9 points (26.3% to 20.4%), whereas the attractiveness and self-sufficiency ratios increased by 2.3 (8.6% to 10.9%) and 8.6 (80.6% to 89.2%) points, respectively. The age- and sex-standardized rate of healthcare utilization for cataract surgery increased by 4.3 points (11.6 to 15.9 cataract surgeries per 1000 inhabitants), making the Cher the second best French area in 2018 for the rate of cataract surgery despite ranking 96th of 109 French areas for ophthalmologist density. The cost of the cataract removal procedure was 523.99€ (666.22€ in the conventional operating room). CONCLUSIONS An ambulatory cataract surgery center with a fast-track procedure could represent a solution in medical deserts to improve cataract healthcare without supplementary funding. Nonetheless, consulting activity should be optimized to detect eye disorders and schedule interventions.
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Affiliation(s)
- Maxime Bigoteau
- From the Department of Ophthalmology, Centre Hospitalier Universitaire Régional de Bretonneau (Bigoteau, Cook, Duroi, Pisella, Khanna), Regional Unit of Epidemiology (EpiDcliC), Service of Medical Information, Epidemiology and Medical Economy, Teaching Hospital of Tours, Medical School, University of Tours (Grammatico-Guillon), Tours; Department of Medical Information, Centre Hospitalier Jacques Coeur (Massot), and Department of Ophthalmology, Centre Hospitalier Jacques Coeur (Bigoteau, Baudet, Pichard, Slim), Bourges, France
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18
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Response to: Comment on "Pain Perception of the First Eye versus the Second Eye during Phacoemulsification under Local Anesthesia for Patients Going through Cataract Surgery: A Systematic Review and Meta-Analysis". J Ophthalmol 2021; 2021:6834852. [PMID: 33564470 PMCID: PMC7850821 DOI: 10.1155/2021/6834852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
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20
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Gabriel RA, Waterman RS, Burton BN, Scandurro S, Urman RD. Patient health status and case complexity of outpatient surgeries at various facility types in the United States: An analysis using the National Anesthesia Clinical Outcomes Registry. J Clin Anesth 2020; 68:110109. [PMID: 33075632 DOI: 10.1016/j.jclinane.2020.110109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/28/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE Among the various types of outpatient surgery centers, there are differences in higher American Society of Anesthesiologists Physical Status (ASA PS) scores and surgical complexity among patients who are undergoing surgery. The primary objective of this study was to describe the differences performed at various types of outpatient surgery facilities. DESIGN We performed a retrospective analysis of the National Anesthesia Clinical Outcomes Registry (NACOR) data. SETTING NACOR from 2012 to 2017. PATIENTS From 2012 to 2017, there were a total of 13,053,115 outpatient surgeries in the database. After removing cases with unknown facility type, the final study sample was 9,217,336. INTERVENTIONS None. MEASUREMENTS To calculate the probability of either American Society of Anesthesiologists Physical Status (ASA PS) score ≥ 3 or physiologically complex cases (defined as Common Procedural Terminology start-up units ≥8), we performed mixed effects logistic regression for each institution per facility type, controlling for year and using facility identification as the random effect. We present the mean rate of these two classifications as case per 10,000 cases and report the 99.9% confidence interval (CI), to control for multiple comparisons. MAIN RESULTS Among all cases, 5,919,844 (64.2%) were classified as ASA PS 1 or 2 and 254,110 (2.8%) of surgical procedures were considered physiologically complex. The mean rate of cases with ASA PS ≥ 3in the university setting was 2982 per 10,000 cases [99.9% CI 2701-3278 per 10,000 cases]. Large community hospitals had a higher proportion of ASA PS ≥3 patients, medium-sized hospitals had no difference, and all other facility types had a decreased proportion. The mean rate of cases that were physiologically complex in the university setting was 133 per 10,000 cases [99.9% CI 117-151 per 10,000 cases]. Large community hospitals had a higher proportion of physiologically complex cases, medium-sized and small-sized hospitals had no difference, and all other facility types had a decreased proportion. CONCLUSIONS Freestanding and attached surgery centers exhibited smaller rates of patients that were ASA PS ≥ 3, as well as a decrease in surgically complex cases, when compared to university settings. This suggests that the level of conservativeness for patient and surgery appropriateness for outpatient surgery differs across various facility types.
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Affiliation(s)
- Rodney A Gabriel
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA; Division of Biomedical Informatics, University of California, San Diego, La Jolla, CA, USA.
| | - Ruth S Waterman
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
| | - Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, CA, USA
| | - Sophia Scandurro
- Department of Biology, University of California, Riverside, CA, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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21
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Comment on "Pain Perception of the First Eye versus the Second Eye during Phacoemulsification under Local Anesthesia for Patients Going through Cataract Surgery: A Systematic Review and Meta-Analysis". J Ophthalmol 2020; 2020:7364767. [PMID: 32774908 PMCID: PMC7399761 DOI: 10.1155/2020/7364767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/08/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
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22
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Fan H, Qian Z, Tzekov R, Lin D, Wang H, Li W. A New Two-Step Anesthesia for 23- or 25-Gauge Vitrectomy Surgery: A Prospective, Randomized Clinical Trial. Ophthalmic Res 2020; 64:34-42. [PMID: 32388512 DOI: 10.1159/000508510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the safety and efficacy of topical anesthesia combined with subconjunctival anesthesia (termed two-step anesthesia) for 23- or 25-gauge pars plana vitrectomy or other posterior segment surgery. METHODS Patients (n = 90) requiring 23-/25-gauge vitrectomy or other posterior segment surgery were randomized into 3 groups. Group 1 received peribulbar anesthesia, group 2 received retrobulbar anesthesia and group 3 received two-step anesthesia. A 5-point visual analog pain scale (VAPS) was used to measure self-report of patient pain. Complications were recorded for subsequent analysis. RESULTS VAPS scores for overall intraoperative pain ranged from 0 to 3 (1.07 ± 1.07) in group 1, from 0 to 2 (0.69 ± 0.93) in group 2 and from 0 to 3 (1.06 ± 0.98) in group 3. Assessment of surgeon discomfort score ranged from 0 to 2 (0.31 ± 0.66) in group 1, from 0 to 3 (0.38 ± 0.82) in group 2 and from 0 to 2 (0.47 ± 0.62) in group 3. Both scores reveal no significant difference among the 3 groups. While there were no complications noted in group 1, there was an ocular perforation in group 2. Additionally, there were no complications in group 3 related to the anesthetic technique. CONCLUSIONS Results suggest that two-step anesthesia is a safe and effective anesthetic approach for selected patients undergoing 23- or 25-gauge pars plana vitrectomy or other posterior segment surgeries. It may offer a viable alternative to peribulbar anesthesia and retrobulbar anesthesia for carefully selected 23- or 25-gauge cannular-access ocular surgeries.
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Affiliation(s)
- Hua Fan
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Zhuyun Qian
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Radouil Tzekov
- Department of Ophthalmology, University of South Florida, Tampa, Florida, USA
| | - Dong Lin
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Hongxia Wang
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China
| | - Wensheng Li
- Department of Retina, Shanghai Aier Eye Hospital, Shanghai, China, .,Aier School of Ophthalmology, Central South University, Changsha, China,
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