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

Abstract

This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

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

“…Due to recent technological advances and improvements in the safety of the procedure, most surgeries are now performed using topical anesthesia with eye drops; therefore, anesthesiologists are rarely required during the procedure. Murray et al [5] reported only one serious adverse event in a series of 6661 cataract surgeries and concluded that most cataract surgery procedures under local anesthesia could be safely performed without the presence of an anesthesiologist.…”

Perioperative Risk Assessment and Avoiding Overuse of Anesthesia Care for Routine Cataract Surgery

“…Several international ophthalmic and nonophthalmic societies have encouraged abandoning or limiting low-value care. 3,4 Among them is the Finnish Medical Society, whose current care guidelines for treatment of adult cataracts 5 justifies the use of general anesthesia in exceptional cases only. These guidelines and the evidence from administrative support systems should inform clinical decision-making and aid in the conversion of practices in the local units.…”

“…1 Drs Nemet and Tuuminen's experiences in Finland add to the growing body of literature suggesting that complications after cataract surgery are exceedingly rare, even though anesthesia care for cataract surgery is used much more selectively at their institution than it is in the US. This approach to cataract surgery sedation is also the prevailing practice throughout the UK, 2 as well as at other dedicated eye care centers, 3,4 and has been shown to be safe and acceptable to patients in these settings.…”

“…Approximately half of patients prescribed CPAP eventually give up on it, risking complications of untreated sleep apnea that include motor vehicle accidents, hypertension, atrial fibrillation, heart failure, stroke, and diabetes. 4 Without surveillance data, the number of patients who abandon CPAP therapy because of discomfort associated with this defect cannot be determined.I have been unable to find data on CPAP abandonment rates by manufacturer. The frequency and consequences of the vibratory snore defect may be substantial, however.…”

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

“…As an example of the spectrum of ambulatory interventions, older patients undergoing cataract surgery often present with significant comorbidities [11 ▪ ]. Still, this surgery can be safely performed in most patients by implementing topical or regional anesthesia, even without preoperative anesthesiologic evaluation [6 ▪ ]. Likewise, even major surgeries such as colectomies can be handled on an ambulatory basis after careful patient selection [12].…”