A review of current ophthalmic anaesthetic practice

Factors associated with satisfaction with oral sedation during ophthalmic surgeries

PURPOSE

To investigate patient and surgical characteristics associated with higher patient, surgeon, or anesthesia provider satisfaction with oral sedation in ophthalmic procedures.

DESIGN

This was a secondary analysis of a prospective, randomized, double-masked, non-inferiority clinical trial measuring patient satisfaction comparing oral versus intravenous (IV) sedation for ophthalmic surgeries.

METHODS

Data was collected from a validated 6-point satisfaction survey from patients, surgeons, and anesthesia providers. We focused on the oral sedation arm and used multivariate regression analysis to investigate the relationship between satisfaction scores and patients' characteristics, surgery duration, and need for additional anesthesia during the ophthalmic procedure.

RESULTS

In total, 142 patients receiving initial oral triazolam with IV placebo were included in this study. Non-White (p = 0.02) and non-English speaker patients (p = 0.003) had higher satisfaction scores with oral sedation. Shorter surgery duration was associated with higher satisfaction scores for both patients (p = 0.01) and surgeons (p = 0.03) but not for anesthesia providers (p = 0.21). The need for supplemental IV sedation intraoperatively was significantly associated with lower satisfaction scores among patients (p < 0.001), surgeons (p < 0.001), and anesthesia providers (p < 0.001).

CONCLUSIONS

Shorter length of surgery was positively associated with higher patient and surgeon satisfaction with oral sedation. Other factors including non-White race and non-English primary language were associated with higher patient satisfaction. Additional IV sedation needed during surgery was associated with worse patient, surgeon, and anesthesia provider satisfaction. Tailoring oral sedation to procedures that are shorter in duration may help maximize the success of oral sedation as an alternative to intravenous sedation.

Inflammatory signal transduction pathways induced by prilocaine toxicity in cultured ARPE-19 cells

Prilocaine (PRL) is a common local anesthetic. Despite the successful use of regional anesthesia for intraocular surgery, there are associated side effects that may affect the retina in case of accidental intravitreal injection. This study examined the signal transduction pathways activated by PRL toxicity and determined the protective role of nitric oxide synthase-2 (NOS2) inhibition in cultured human-derived retinal pigment epithelial cells (ARPE-19). Toxicity analysis was performed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide assay to detect the toxic dose of PRL and protective effectiveness of asperglaucide (ASP), an NOS2 inhibitor. Nuclear factor kappa B p65 (NF-κB p65), phosphorylated NF-κB p65, phospho-protein kinase B (AKT), NOS2, nitrotyrosine, and cleaved caspase-3 protein levels were evaluated by immunofluorescence staining and/or western blot analysis. Interleukin-6 (IL-6) and nitrated protein levels were quantified using an immunoassay, whereas caspase-3 activity and nitrite/nitrate levels were measured using a fluorometric method. A significant increase in NF-κB p65, and phosphorylated NF-κB p65 and AKT levels due to PRL toxicity was observed. Similarly, IL-6, NOS2, nitrite/nitrate, and nitrotyrosine levels were significantly higher in PRL-treated cells than in control cells. Application of ASP to PRL-treated cells reduced NF-κB p65, and phosphorylated NF-κB p65 and AKT to basal levels. IL-6, NOS2, nitrite/nitrate, and nitrotyrosine levels also considerably decreased following ASP treatment in cells experiencing PRL-induced toxicity. Moreover, the caspase-3-dependent apoptotic pathway was not activated. Our results indicate that ASP could ameliorate PRL-induced activation of NF-κB p65 that led to inflammation in cultured ARPE-19 cells.