Is there an effect of perioperative blood pressure on intraoperative complications during phacoemulsification surgery under local anaesthesia?

Abstract

Purpose The practice of deferring phacoemulsification procedure on recording raised blood pressure (BP) in the immediate perioperative period is based on the perception of increased intraoperative risk. The significance of perioperative BP recordings on the surgical complications during phacoemulsification procedure was evaluated. Setting: Hairmyres Hospitals, Lanarkshire Acute Hospitals NHS Trust. Patients and methods Patients were classified as hypertensive on the basis of the British Hypertension Society Guidelines. BP recordings during preoperative assessment, admission, and 1-hour postoperatively were recorded in 734 hypertensives and 740 normotensives undergoing phacoemulsification procedure. In addition, BP recordings in the holding area before giving local anaesthesia were noted in the 734 hypertensives. Patient's peri-and intraoperative complications during the procedure were noted. Results The mean age was 72 ± 10.5 years and 74±11.6 years among the hypertensives and normotensives. There was a significant increase in the number of hypertensives who developed isolated systolic hypertension in the holding area (95% confidence interval ¼ 2.82, Po0.001) where the mean BP was 171.38/78.31 mm Hg ( ± 30.55/16.29). A total of 21 hypertensives and 18 normotensives developed intraoperative complications during the phacoemulsification procedure. There was no significant difference (P ¼ 0.41) in the intraoperative complications between the hypertensives and normotensives. Conclusion Perioperative increase in BP noted in the holding area among hypertensives did not increase the risk of surgical complications during phacoemulsification procedure when compared with normotensives. We recommend that BP should not be routinely measured in the holding area before phacoemulsification surgery under local anaesthesia.

Is perioperative blood pressure monitoring during intravitreal injections important?

“…[1][2][3] A perioperative rise in blood pressure (BP) has been noted during cataract surgery. [4][5][6][7][8] In fact, the guidelines from the American Academy of Ophthalmology suggest that BP monitoring should be performed during cataract surgery by personnel, other than the operating ophthalmologist, who is qualified to monitor and manage the patient's systemic status. 9,10 In addition to the intraoperative BP rise, intravitreal anti-VEGF injections have been demonstrated to increase the lifelong risk of cardiovascular and cerebrovascular events.…”

Hypertension and cataract surgery under loco-regional anaesthesia: not to be ignored?

“…There were no systemic complications, such as cardiac arrest, myocardial infarction or stroke. 14 These findings were affirmed by a recent study concluding that preoperative evaluation had no role in reducing adverse events in patients undergoing cataract surgery, and hypertensive episodes observed in this patient population were not associated with any adverse medical or surgical outcomes. 15 Guerrier and colleagues 15 studied 514 cataract surgery patients under topical anaesthesia.…”

“…The aforementioned study of 734 hypertensive patients, who had no perioperative intervention for elevated blood pressure, had no significant difference in surgical complications compared with normotensives. 14 In a prospective study of 108 cases of suprachoroidal haemorrhage complicating cataract surgery from 13 centres participating in the United Kingdom British Ophthalmological Surveillance Unit, 21 univariate analysis of potential risk factors found no significant effect of hypertension. Often, cataract and glaucoma procedures are combined.…”

“…There were no calls to the emergency team during or after surgery, intraocular haemorrhage, unplanned hospital admission, morbidity or mortality attributed to this process during the whole of the study period. The aforementioned UK series 14 of 734 hypertensive cataract patients, including 87 patients (12%) with SBP !180 mm Hg or DBP !110 mm Hg and no systemic adverse events, concluded that patients undergoing cataract surgery under local anaesthesia should not be cancelled because of raised blood pressure in the immediate preoperative period.…”

Prevalence of Coexisting Systemic and Ocular Diseases among Cataract Surgery Patients: A Study in a Teaching Hospital in North East Malaysia

“…Significant bleeding is extremely rare during phacoemulsification cataract surgery and even large incision extracapsular or intracapsular cataract surgery. In a study of 734 hypertensive patients, who had no perioperative intervention for elevated blood pressure, had no significant difference in surgical complications compared with normotensives [20]. In a prospective study of 108 cases of suprachoroidal haemorrhage complicating cataract surgery from 13 centres participating in the United Kingdom British Ophthalmological Surveillance Unit [21], univariate analysis of potential risk factors found no significant effect of hypertension.…”