Oral Sedation Anesthesia Protocol for In-Office Oculoplastic Surgery

Abstract

Purpose: To present an oral anesthesia protocol for in-office oculoplastic surgery and to compare safety outcomes and patient and physician experiences to ambulatory surgery center (ASC)-based surgery with intravenous sedation or general anesthesia. Methods: A prospective study was performed on consecutive patients undergoing surgery at an oculofacial plastic surgery practice. Surgery was performed in an in-office setting using our standardized oral sedation protocol or at an ASC with intravenous sedation or general anesthesia. Preoperative and postoperative surveys were conducted by patients and physicians to compare surgical experience, safety, and efficacy of our oral sedation protocol for in-office surgery in the ASC setting. Results: Two hundred and fifty-three patients (167 in-office and 86 at ASC) underwent surgery between March and November 2022. There was no significant difference in how patients or physicians rated their experience between the 2 locations. A significantly higher proportion of ASC patients would have rather had surgery in-office (34.9% vs. 19.2%; p = 0.006). A significantly higher number of physicians in the office setting would have rather performed surgery at the ASC than the reverse (12.7% vs. 2.3%, respectfully; p = 0.007). There were no safety complications reported in either setting. Conclusions: Within our patient cohort, the presented oral sedation protocol provided safe and effective anesthesia for in-office oculoplastic surgery that is comparable to an ASC.

Performing In-office Oculoplastics Procedures

“…In addition to higher reimbursement and allowing the surgeon more efficiency, OBS may also be more convenient and desirable for patients. A recent study by Conger et al 2 found that significantly more patients would prefer to have their oculoplastic surgery performed in an OBS setting rather than an ASC. Interestingly, the same study found the reverse to be true for physicians, with more surgeons preferring to perform the surgery in an ASC than in the office 2 …”

“…However, some patients may become disinhibited with sedation, and in elderly patients, there is a risk of postoperative delirium. In cataract surgery, oral benzodiazepine sedation has been shown in multiple studies to be equivalent to intravenous sedation in terms of patient satisfaction and safety, 5–7 and this is echoed for oculoplastics surgery and Moh surgery 2,8,9 . Recently, Conger et al 2 published an oral sedation protocol for office-based oculoplastic surgery.…”

“…In cataract surgery, oral benzodiazepine sedation has been shown in multiple studies to be equivalent to intravenous sedation in terms of patient satisfaction and safety, 5–7 and this is echoed for oculoplastics surgery and Moh surgery 2,8,9 . Recently, Conger et al 2 published an oral sedation protocol for office-based oculoplastic surgery. Approximately 30 minutes before the procedure, patients were given 1.5 mg of oral lorazepam (or 2 mg if they were more than 200 lbs) along with 200 mg of oral celecoxib.…”

“…If SBP was found to be >200 mm Hg or did not improve after clonidine, then the case was canceled. Next local anesthesia was administered with a 1:1:1 ratio of normal saline, 1% lidocaine with 1:100,000 epinephrine, and 0.5% bupivacaine with 1:200,000 epinephrine, with 0.5 mL of bicarbonate per 10 mL administered on a 25-gauge, 5/8-inch needle 2 …”