Safety of cataract surgery under topical anesthesia with oral sedation without anesthetic monitoring

Rocha, Guillermo; Turner, Caroline

doi:10.3129/can.j.ophthalmol.i07-034

Cited by 27 publications

(22 citation statements)

References 21 publications

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“…23 One bonus of topical anesthesia, especially in patients who have vision in the operated eye only, is that visual recovery is almost immediate.…”

Section: Topical Anesthesiamentioning

confidence: 99%

“…13,18 Because the corneal incision is inherently small, stepped, and self sealing, very little manipulation is required and this has allowed the use of sub-Tenon [19][20][21][22] and topical anesthesia. 13,[23][24][25] Any anesthesia technique for cataract surgery must strive for patient safety, comfort, and the attainment of safe conditions for the necessary surgery. Essentially, the anesthesia modality must be assessed on an individual patient and surgeon basis.…”

Section: Progression and Historical Development Of Surgical Techniquementioning

confidence: 99%

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Local anesthesia for cataract surgery

Malik¹,

Fletcher²,

Chong³

et al. 2010

Journal of Cataract and Refractive Surgery

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Various aspects of local anesthesia for cataract surgery, such as the anesthetic agents and their interaction with ocular nerve supply, anesthesia requirements, available clinical techniques and their inherent complications are reviewed. A comparative evaluation of clinical techniques in terms of efficacy, akinesia, and patient-perceived pain during both anesthesia administration and intraoperative cataract surgery is presented, along with the prevailing practice patterns of anesthesia techniques among refractive surgeons in the United Kingdom and United States. More randomized clinical trials are needed to facilitate statistical methods of metaanalysis to establish convincingly the overall benefits and efficacy of the various local anesthesia procedures in cataract surgery. The wide scope of the present review is of relevance in structuring ophthalmology and anesthesia specialist training programs for junior staff.

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“…23 One bonus of topical anesthesia, especially in patients who have vision in the operated eye only, is that visual recovery is almost immediate.…”

Section: Topical Anesthesiamentioning

confidence: 99%

Section: Progression and Historical Development Of Surgical Techniquementioning

confidence: 99%

Local anesthesia for cataract surgery

Malik¹,

Fletcher²,

Chong³

et al. 2010

Journal of Cataract and Refractive Surgery

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“…7 Conventionally used injection technique had preoperative pain as well as the mild to very severe complications; hence application of topical gel seems to be better option in patient care. [8][9][10][11][12] These advantages of gel could be due to the increased contact time and prolonged duration of action of 20-25 minutes as compared to 15-20 minutes for drops. 13,14 In 90% of gel patients the duration of surgery is similar to the average time with injection technique, showing similar surgeon's comfort.…”

Section: Discussionmentioning

confidence: 99%

A study on the effect of topical lidocaine gel versus drops on surgeon’s comfort during manual small incision cataract surgery

Krishnan¹,

Sam²,

Kuriachan³

et al. 2018

Int J Basic Clin Pharmacol

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Background: Cataract is a frequent surgical procedure performed worldwide. The study compared lidocaine 4% drops with 2% gel on surgeon’s comfort, need for supplemental anaesthesia and duration of surgery in patients who underwent manual small incision cataract surgery.Methods: This was a Prospective, Comparison study conducted at a Single centre by multiple surgeons. Patients enrolled for surgeries were divided into Group A: Lidocaine 4% drops 1ml was instilled in the conjunctival sac 5 minutes before surgery and Group B: Lidocaine 2% gel 2ml was applied. Endpoints evaluated were surgeon’s comfort, need for supplemental anesthesia and duration of surgery.Results: The mean duration of surgery for gel was 20±8 minutes as compared to 29±6 minutes with drops (p*- value<0.001). 26 (87%) patients in gel did not require any supplemental anesthesia as compared to 3 (10%) patients in drops. Peribulbar supplementation was required for 20 (67%) patients in drops as compared to 1 (3%) patient in gel (p*- value<0.001). 26 (87%) patients in gel were operated comfortably by the surgeon as compared to 2 (6%) patients in drops. Mild to Moderate discomfort was experienced by the surgeon in operating 27 (90%) patients in drops as compared to 3(10%) patients in gel (p*- value<0.001).Conclusions: The surgeons were more comfortable using gel with least requirement of supplemental anaesthesia and faster completion compared to drops.

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“…The oral mucosa provides a direct route to venous circulation via the sublingual veins (Figure 1), while avoiding the need for intravascular devices. Midazolam, due to its short half-life, allows for rapid onset of sedation and quick post-operative recovery [6][7][8][9][10]. We describe herein the use of midazolam via combined sublingual and oral routes without an intravenous line for routine topical phacoemulsification with IOL.…”

Section: Introductionmentioning

confidence: 99%

Sublingual plus oral midazolam without intravenous access to complement topical anesthesia for phacoemulsification surgery

Gelinas¹,

Silbernagel²,

McCanna³

et al. 2017

New Front Ophthalmol

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Purpose: To evaluate sublingual/oral midazolam in phacoemulsification patients with no intravenous line. Design: prospective, consecutive case series as part of a quality assurance program. Methods:Two surgeons' data from 193 consecutive procedures receiving sublingual plus oral midazolam were analyzed for total midazolam dose, need for additional medications, nausea/vomiting, respiratory depression, and total monitoring time. Low health-risk (American Society of Anesthesiologist 2 (ASA2) and higher health-risk (American Society of Anesthesiologist 3(ASA3)) groups were compared.Results: There were no statistical differences between groups, except ASA2 cases required more midazolam syrup than ASA3 cases (5.94 ± 0.18 vs. 5.08 ± 0.08 mg, p < 0.001). Fewer than 3% of all cases needed additional medication or experienced nausea. Average time monitored was under 80 minutes. One patient had mild (successfully treated) respiratory depression. Only 3 cases required additional syrup, and only 3 intravenous lines were started. There were no intraoperative events. Conclusion:Sublingual/oral midazolam without intravenous line is a safe, efficient complement to topical anaesthesia for phacoemulsification with IOL. PrecisSublingual/oral midazolam without intravenous line is a safe, efficient means of achieving monitored anaesthesia care for phacoemulsification with IOL that offers advantages to both patient and surgeon.

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Safety of cataract surgery under topical anesthesia with oral sedation without anesthetic monitoring

Cited by 27 publications

References 21 publications

Local anesthesia for cataract surgery

Local anesthesia for cataract surgery

A study on the effect of topical lidocaine gel versus drops on surgeon’s comfort during manual small incision cataract surgery

Sublingual plus oral midazolam without intravenous access to complement topical anesthesia for phacoemulsification surgery

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