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Chauhan MZ, Soliman MK, Pace NL, Mathis MR, Schonberger RB, Sallam AB. Anesthesia Techniques for Vitreoretinal Surgery in the United States: A Report from the Multicenter Perioperative Outcomes Group Research Consortium. Am J Ophthalmol 2024:S0002-9394(24)00253-8. [PMID: 38871268 DOI: 10.1016/j.ajo.2024.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/28/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE To explore the patterns of anesthesia use and their determinants during vitreoretinal (VR) surgeries in academic and community hospitals across the US, using data from the Multicenter Perioperative Outcomes Group (MPOG). DESIGN A retrospective, multicenter, cohort study. METHODS We queried the MPOG database of 107,066 patients undergoing VR surgeries. Patients (≥18 yrs.) undergoing VR surgery with monitored anesthesia care (MAC) or general anesthesia (GA) from January 1, 2015, to December 31, 2021 were included. Patient-level, case-based, and institutional-level covariates were collected. We performed multivariable mixed-effects models to determine predictors of anesthesia type use. The primary outcome was the type of anesthesia (MAC or GA) used during VR surgeries. As a secondary outcome, MAC cases were further classified based on the additional use of sedation into MAC with or without sedation. RESULTS We found that 67.45% of VR surgery cases received MAC, and 73.63% of institutions administered MAC to more than half of cases. Random effect modeling revealed that 47.76% of the variation in MAC use was attributed to institutions. A trend toward increased use of MAC with increasing age was observed. Patients diagnosed with chronic pulmonary disease, liver disease, or a history of drug abuse were less likely to receive MAC. Conversely, we found that patients with reported alcohol abuse disorder, diabetes with complications, and those with American Society of Anesthesiologists (ASA) physical status of 4 (vs. 1, 2, or 3) were more likely to use MAC. Compared to non-complex VR surgeries, there was a notably decreased likelihood of MAC use in complex PPV (P = 0.004), PPV + scleral buckle (SB) for retinal detachment (P < 0.0001), and primary SB surgery (P < 0.0001). CONCLUSIONS Approximately 2/3 of VR anesthesia is under MAC, but GA is still preferred for SBs, complex vitrectomy, and younger patients. We show that large interinstitutional variation for using MAC in practice exists.
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Affiliation(s)
- Muhammad Z Chauhan
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Mohamed K Soliman
- University Hospitals Eye Institute, Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio; Department of Ophthalmology, Assiut University Hospitals, Faculty of Medicine, Assiut, Egypt
| | - Nathan L Pace
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Michael R Mathis
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | - Ahmed B Sallam
- Department of Ophthalmology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
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Behera G, Kothari A, Subramanian A, Jayaraman R, Rene S. Comparing Peribulbar and Topical Anesthesia in Cataract Surgery among Patients with Cardiovascular Disease. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:71-76. [PMID: 38224720 PMCID: PMC10869419 DOI: 10.3341/kjo.2023.0123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/10/2024] [Indexed: 01/17/2024] Open
Abstract
PURPOSE To compare topical and peribulbar anesthesia in cataract surgery for hemodynamic changes, rate of complications and pain score in patients with cardiovascular disease. METHODS A prospective comparative study at a tertiary care center in India. Patients >40 years old with treated/controlled hypertension and cardiovascular disease scheduled for cataract surgery under topical or peribulbar anesthesia were recruited. Heart rate, blood pressure, and ophthalmic and systemic complications were noted: preoperatively, immediately after block, intraoperatively, immediately postoperatively and 1 hour postoperatively. A visual analog scale was used to assess the pain score. RESULTS A total of 150 patients (75 in each group) underwent cataract surgery. There was a significant rise in pulse rate and blood pressure after peribulbar injection and intraoperatively, which gradually reduced to baseline 1 hour after surgery in both groups (p < 0.001), with systolic blood pressure intraoperatively being significantly greater in the peribulbar group (155.49 ±18.14 mmHg vs. 147.95 ±17.71 mmHg, p = 0.01). The topical group had slightly lower visual analog scale scores (1.12 ± 0.99) than the peribulbar group (1.44 ± 0.90, p = 0.04). CONCLUSIONS Cataract surgery appears safe in patients with adequately controlled cardiovascular disease, and topical anesthesia may be preferable due to noninvasiveness, adequate analgesia, and minimal effect on hemodynamic parameters. Therefore, hemodynamically stable patients of cardiovascular disease undergoing uncomplicated cataract surgery may be counselled for topical anesthesia.
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Affiliation(s)
- Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry,
India
| | - Akhilesh Kothari
- Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
| | - Anandaraja Subramanian
- Department of Cardiology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
| | - Ramesh Jayaraman
- Department of Internal Medicine, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
| | - Senthamizhan Rene
- Department of Ophthalmology, Indira Gandhi Government General Hospital and Post Graduate Institute, Puducherry,
India
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Siddiqui MZ, Chauhan MZ, Stewart AF, Sallam AB. Analysis of Operational Efficiency and Cost Differences between Local and General Anesthesia for Vitreoretinal Surgery. Healthcare (Basel) 2022; 10:healthcare10101918. [PMID: 36292366 PMCID: PMC9601387 DOI: 10.3390/healthcare10101918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 11/04/2022] Open
Abstract
There has been a growing trend of using local anesthesia (LA) compared to general anesthesia (GA) over the last two decades in VR surgery. We aim to answer the following question: what is the institutional benefit of LA versus GA use in operation-room time, anesthesia duration, earlier discharge from an outpatient surgery facility, and the estimated cost savings? We conducted a retrospective analysis of 1476 eyes that underwent vitreoretinal surgery over a 6-year period from a single site; 61.8% of patients received GA and 38.2% received LA for VR surgery. Anesthesia, surgical, and recovery times were significantly shorter with LA (100.49, 66.47, 66.47 mins) vs. GA (145.53, 100.14, 75.08 mins). Anesthesia, surgical, and recovery costs were significantly lower for eyes that received LA, with an estimated adjusted cost reduction of USD 1516 per surgery using LA instead of GA. Use of LA for vitreoretinal surgery is associated with better operational efficiency, earlier patient discharge, and significant cost reduction.
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Affiliation(s)
- Mohammad Z. Siddiqui
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Muhammad Z. Chauhan
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Alvin F. Stewart
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Ahmed B. Sallam
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
- Correspondence: ; Tel.: +501-686-5822; Fax: +501-686-7037
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Choi JV, Cheung RM, Mozel MR, Merchant RN, Lee SM. Perioperative outcomes following preoperative epidural analgesia in hip fracture patients undergoing surgical repair: A systematic review. PAIN MEDICINE 2021; 23:234-245. [PMID: 34022058 DOI: 10.1093/pm/pnab176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the effectiveness and safety of epidural analgesia in the presurgical period on hip fracture patients undergoing surgical repair. DESIGN Systematic review. METHODS The study protocol was registered with the PROSPERO systematic reviews register: CRD42019140396. Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia to other forms of pain management in hip fracture patients. The primary outcomes included perioperative cardiac events and mortality. Pain, non-cardiac complications, and adverse effects were also examined as secondary outcomes. Heterogeneity of the included studies was assessed using the I2 statistic and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated. RESULTS Four studies met the inclusion criteria, which included a total of 221 patients. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (RR 0.30; 95% CI 0.14-0.63; I2 = 0%). Preoperative epidural analgesia was also associated with decreased perioperative mortality in a meta-analysis of two studies (RR 0.13; 95% CI 0.02-0.98; I2 = 0%). Pain was not pooled due to variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies. CONCLUSIONS Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and mortality, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for hip fractured patients.
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Affiliation(s)
- Jonathan V Choi
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia. Orcid ID: 0000-0002-5341-2397
| | - Rachel M Cheung
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia
| | | | - Richard N Merchant
- Department of Anesthesia, Royal Columbian Hospital; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia Orcid ID: 0000-0002-8526-2477
| | - Susan M Lee
- Department of Anesthesia, Royal Columbian Hospital; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia Orcid ID: 0000-0001-9016-310X
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Modabber M, Dan AF, Coussa RG, Flanders M. Retrobulbar anaesthesia for adjustable strabismus surgery in adults: a prospective observational study. Can J Ophthalmol 2018; 53:621-626. [PMID: 30502988 DOI: 10.1016/j.jcjo.2018.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/22/2018] [Accepted: 02/27/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize the ocular response to retrobulbar anaesthesia and to evaluate the efficacy of retrobulbar anaesthesia for adjustable strabismus surgery in adults. DESIGN Prospective observational study. PARTICIPANTS Adult patients undergoing adjustable strabismus surgery under retrobulbar anaesthesia. METHODS Surgical success was defined by ocular alignment within 10 prism diopters (PD) of orthotropia for horizontal rectus surgery and within 5 PD for vertical rectus surgery. After retrobulbar injection of Xylocaine with epinephrine, the onset time and the degree of visual impairment, ocular akinesia, and analgesia were evaluated. Postoperative parameters included the restoration of vision, onset of pain, resolution of ptosis, normalization of pupil, resolution of extraocular motility deficits, and the timing of postoperative adjustment. Perioperative complications were also documented. RESULTS A total of 33 patients were initially included in this study. Two patients experienced complications (perioperative retrobulbar hemorrhage, postoperative suprachoroidal hemorrhage) and were excluded from data analysis. Of the remaining 31 patients (mean age, 50.2 ± 14.8 years), surgical outcome was satisfactory in 30/31 (96.8%) patients at the first postoperative visit and in 15/19 (78.9%) cases at last follow-up (mean, 6.1 ± 1.6 months). Excellent intraoperative ocular akinesia and analgesia was achieved with retrobulbar anaesthesia. After retrobulbar injection, visual impairment was the first to resolve to preoperative levels within (mean ± SD) 3.7 ± 1.9 hours postinjection, followed by onset of pain at 4.1 ± 1.0 hours, resolution of ptosis at 4.3 ± 1.9 hours, and normalization of pupil reactivity at 6.1 ± 1.0 hours. The resolution of anaesthesia upon extraocular motility occurred within 5.7 ± 1.0 hours postinjection (range, 4.5-8.0 hours), allowing for subsequent same-day postoperative adjustment. CONCLUSIONS Retrobulbar anaesthesia in the context of adult, adjustable strabismus surgery is a relatively safe and effective technique. It provides excellent intraoperative analgesia and akinesia. Retrobulbar anaesthesia enables for same-day suture adjustments to be reliably performed.
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Affiliation(s)
- Milad Modabber
- Department of Ophthalmology, McGill University, Montréal, Qué..
| | - Andrei F Dan
- The School of Medicine, McGill University, Montréal, Qué
| | - Razek G Coussa
- Department of Ophthalmology, McGill University, Montréal, Qué
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Haddadi S, Shahrokhirad R, Ansar MM, Marzban S, Akbari M, Parvizi A. Efficacy of Preoperative Administration of Acetaminophen and Melatonin on Retrobulbar Block Associated Pain in Cataract Surgery. Anesth Pain Med 2018; 8:e61041. [PMID: 30533388 PMCID: PMC6240829 DOI: 10.5812/aapm.61041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 07/25/2018] [Accepted: 08/08/2018] [Indexed: 12/16/2022] Open
Abstract
Background Retrobulbar block is one of the chosen methods for local anesthesia in cataract surgery. Since it is a painful procedure, using analgesic and sedative drugs is recommended. Current medications have side effects and evaluating of new drugs or new uses of existing safer drugs is necessary. Objectives The aim of this study was to compare the administration of melatonin and acetaminophen on pain and hemodynamic changes during retrobulbar block. Methods In a double-blinded randomized trial, 180 patients undergoing cataract surgery were randomly divided into three groups: Melatonin group (received melatonin 6 mg), acetaminophen group (received acetaminophen 500 mg), and control group (received placebo). All drugs were administered orally 60 min before arrival to the operating room by nurses blinded to the drugs administered. All patients received fentanyl 0.5 μg/kg before retrobulbar block intravenously. Hemodynamic variables and pain score in each patient were evaluated on arrival in the operating room, during retrobulbar block, during surgery, 20 min after operation, at the end of surgery, and in the recovery room. In case of pain score more than three, additional fentanyl was administered. All data were recorded in structured data sheets. Results Data analysis indicated no significant differences among the groups at baseline on any of the demographic variables. Both acetaminophen and melatonin reduced the pain score significantly compared with control during retrobulbar block (P < 0.05 and P < 0.01, respectively). Administration of additional fentanyl was significantly lower in the melatonin group than the control group (P < 0.05). Hemodynamic changes were not significantly different among all groups. Conclusions For the first time, as far as we have studied, the analgesic effect of acetaminophen on the retrobulbar block was indicated. We also showed that melatonin can reduce pain during retrobulbar block leading to reduction of additional fentanyl during operation. It seems that both melatonin and acetaminophen may have a beneficial effect on pain control in the retrobulbar block.
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Affiliation(s)
- Soudabeh Haddadi
- Anesthesiology Research Center, Department of Anesthesiology, Al-Zahral Hospital, Guilan University of Medical Sciences, Rasht , Iran
| | - Reyhaneh Shahrokhirad
- Anesthesiology Research Center, Department of Anesthesiology, Al-Zahral Hospital, Guilan University of Medical Sciences, Rasht , Iran
| | - Malek Moien Ansar
- Neuroscience Research Center, Department of Biochemistry, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Department of Biochemistry, Guilan University of Medical Sciences, Rasht, Iran
- Corresponding Author: Department of Biochemistry, Guilan University of Medical Sciences, Rasht ,Iran. Tel: +98-9113313463,
| | - Shideh Marzban
- Anesthesiology Research Center, Department of Anesthesiology, Al-Zahral Hospital, Guilan University of Medical Sciences, Rasht , Iran
| | - Mitra Akbari
- Ophthalmic Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Arman Parvizi
- Anesthesiology Research Center, Department of Anesthesiology, Al-Zahral Hospital, Guilan University of Medical Sciences, Rasht , Iran
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Zawar S, Kolte R. Pain-free cataract surgery in patients with cardiac risk. Indian J Ophthalmol 2012; 60:157. [PMID: 22446920 PMCID: PMC3339084 DOI: 10.4103/0301-4738.94063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nanda S, Gupta A, Kulshreshtha A, Kalra P, Sharma M. Anesthetic management of a 137-year-old patient fracture of neck femur. J Anaesthesiol Clin Pharmacol 2012; 28:143-4. [PMID: 22345978 PMCID: PMC3275963 DOI: 10.4103/0970-9185.92480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Samridhi Nanda
- Department of Anaesthesia, Pt. Madan Mohan Malviya Hospital, New Delhi, India
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Smith RL, Young SJ, Greer IA. The parturient with coronary heart disease. Int J Obstet Anesth 2008; 17:46-52. [PMID: 17698337 DOI: 10.1016/j.ijoa.2007.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 04/01/2007] [Indexed: 11/30/2022]
Abstract
Cardiac disease is one of the leading indirect causes of maternal mortality in the UK, exceeding numbers of direct deaths from thromboembolism and hypertension combined. Over one year in our unit we managed six women with coronary heart disease. In this series five women had stable coronary heart disease. Three delivered electively by caesarean section under combined spinal-epidural anaesthesia, a further two women had spontaneous vaginal deliveries, one planned under epidural analgesia, the second unplanned after a rapid labour. The sixth woman had unstable angina requiring percutaneous coronary intervention in the 28th week of pregnancy and went on to deliver by caesarean section under general anaesthesia. Regional anaesthesia was avoided in this case because of antiplatelet and anticoagulant medication. There is a lack of level-one evidence to direct the management of these women. Clinical decisions were directed by guidelines for the perioperative management of patients with cardiac disease in non-cardiac surgery and the management of all cardiac disease in the obstetric population. A multi-disciplinary approach was taken, with a collaborative plan made for each pregnancy and delivery. A thorough clinical history and examination together with transthoracic echocardiography allows risk stratification of women with coronary heart disease at risk of peripartum cardiac events. Further investigation specific to each woman's management can then be undertaken.
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Affiliation(s)
- R L Smith
- Department of Anaesthesia, Princess Royal Maternity Hospital, Glasgow UK
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Mistraletti G, De La Cuadra-Fontaine JC, Asenjo FJ, Donatelli F, Wykes L, Schricker T, Carli F. Comparison of Analgesic Methods for Total Knee Arthroplasty. Reg Anesth Pain Med 2006. [DOI: 10.1097/00115550-200605000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lebuisson DA, Jolivet MC. L’anesthésie topique en chirurgie de la cataracte ambulatoire de l’adulte sans anesthésiste présent. J Fr Ophtalmol 2005; 28:59-67. [PMID: 15767901 DOI: 10.1016/s0181-5512(05)81027-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To review the local anesthesia environment in France in adult out-patient cataract surgery. The author considers the presence or absence of an anesthesiologist in the operating room. The report shows that in many circumstances there is no need for an anesthesiologist if the following criteria are respected: the adult is fully informed, in rather good health, with no acute risk factors, and surgery is performed by a senior surgeon in a certified operating room. In France, a move toward more flexible regulations is expected, with a new cooperation between ophthalmologists and anesthesiologists that will lead to a new true risk/benefit/obligation ratio. Respect of the individual and safety remain crucial requirements making systematic generalizations impossible.
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Affiliation(s)
- D A Lebuisson
- Service d'Ophtalmologie, Unité de chirurgie ambulatoire, Hôpital Foch, 40 rue Worth, 92159 Suresnes, France.
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MacPherson R. Structured assessment tool to evaluate patient suitability for cataract surgery under local anaesthesia. Br J Anaesth 2004; 93:521-4. [PMID: 15321931 DOI: 10.1093/bja/aeh243] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Cataract extraction and intraocular lens implantation is a common surgical procedure. While the vast majority of these operations are performed under local anaesthesia (LA), this is not an appropriate technique for every patient. Likewise it is time-consuming to assess all patients fitness for general anaesthesia when most will not need it. METHODS We developed an eight-item questionnaire that can be administered before admission to assess patient suitability for surgery under LA. In a prospective study over a 9-month period, 128 patients were seen in a pre-admission clinic, and according to the responses to the questionnaire administered by junior medical staff, 123 were deemed suitable for surgery under LA, and five under general anaesthetic (GA). RESULTS All 123 patients went on to have surgery successfully performed under LA. A further two patients from the GA group were determined by the attending anaesthetist to be suitable for surgery under LA. CONCLUSION This assessment instrument has been shown to be a highly specific means of selecting patients for surgery under LA, and can be administered by medical or nursing staff.
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Affiliation(s)
- R MacPherson
- Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
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Abstract
Elderly patients represent the majority of the surgical population scheduled for ophthalmological surgery. Eye surgery is usually minimally invasive, enabling most of the procedures to be performed as day-case surgery despite the high co-morbidity of these patients. This, however, requires a specific perioperative anaesthetic strategy. In this chapter we address features of perioperative care in the geriatric population undergoing eye surgery, from pre-medication and pre-operative testing, to choice and performance of anaesthesia, and finally to post-anaesthesia care.
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Affiliation(s)
- Jens C Kubitz
- Department of Anaesthesiology, Ludwig-Maximillians-University Munich, Nussbaumstrasse 20, D-80336 Munich, Germany.
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Glantz L, Ezri T, Cohen Y, Konichezky S, Caspi A, Geva D, Leviav A. Perioperative myocardial ischemia in patients undergoing sternectomy shortly after coronary artery bypass grafting. Anesth Analg 2003; 96:1566-1571. [PMID: 12760976 DOI: 10.1213/01.ane.0000062521.96996.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Coronary revascularization reduces cardiac complications associated with noncardiac surgery in patients with severe coronary disease. However, patients undergoing emergency noncardiac surgery soon after coronary bypass operations may still be vulnerable to ischemic myocardial events. We prospectively evaluated the incidence of myocardial ischemia in 82 consecutive patents scheduled for sternectomy in the first (Group 1; 35 patients) or second (Group 2; 47 patients) week after coronary artery bypass graft (CABG) surgery. The interval between CABG surgery and sternectomy in Groups 1 and 2 was 6 days (range, 4-7 days) and 11 days (range, 8-14 days), respectively. Electrocardiographic (ECG) changes consistent with myocardial ischemia were assessed with a two-channel Holter system for 48 h. There were no between-group differences in updated Acute Physiology and Chronic Health Evaluation score, use of beta-blockers, or perioperative hemodynamic changes. The incidence of ECG changes consistent with myocardial ischemia was fivefold more frequent in Group 1 (22.85% versus 4.25%; P < 0.05). Of the ischemic patients in Group 1, 25% experienced a perioperative acute myocardial infarction (one was fatal). There were no infarcts in Group 2. Thus, patients appear to be prone to coronary events during sternectomy performed early after CABG surgery. Although the incidence of ischemia did not differ from that previously reported after CABG surgery alone, further investigation is required to determine whether the findings obtained in this high-risk population are generalizable to patients undergoing noncardiac surgery soon after uneventful CABG surgery. IMPLICATIONS This study demonstrates an increased incidence of myocardial ischemia when sternectomy for mediastinitis is performed within one week of coronary artery bypass graft surgery, and this ischemia is associated with a 25% incidence of myocardial infarction.
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Affiliation(s)
- Lucio Glantz
- *Department of Anesthesiology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel; †Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; ‡Department of Anesthesiology, Wolfson Medical Center, Holon, Israel; §Department of Anesthesiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and ∥Intensive Care Unit and Departments of ¶Cardiology, #Anesthesiology, and **Plastic Surgery, Kaplan Medical Center, Rehovot, Israel (affiliated with The Hebrew University School of Medicine, Jerusalem, Israel)
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Abstract
PURPOSE OF REVIEW Ambulatory surgery is now one of the major areas of surgical and anesthetic practice, with up to 70% of procedures performed in the ambulatory setting. This review focuses on some of the recent studies performed in day case anesthesia. RECENT FINDINGS Emphasizing the economic benefits of ambulatory surgery, investigators have studied the cost implications of various anesthetic techniques and their impact on patient recovery, discharge times and readmission rates. Quality anesthetic management measures such as mortality, morbidity, postoperative stay and patient satisfaction ensure that perioperative care and treatment are optimized. SUMMARY Careful patient selection can minimize perioperative events. The concept of multimodal analgesic and antiemetic therapy, in combination with newer anesthetic drugs, help expand the field of ambulatory surgery.
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Affiliation(s)
- Anne Marie Troy
- Department of Anaesthesia, Royal College of Surgeons in Ireland, Dublin, Ireland
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Abstract
PURPOSE OF REVIEW To summarize recent knowledge concerning ophthalmic regional anaesthesia. RECENT FINDINGS Ophthalmic regional anaesthesia has changed considerably over the past few years. Alternatives to retrobulbar anaesthesia have been proposed to reduce the number of complications without detriment to efficiency. Finally new local anaesthetics have been adopted and the indications have broadened, especially in vitroretineal surgery. SUMMARY New developments in ophthalmic regional anaesthesia are presented in this review. Different methods, indications and side effects are described in order to facilitate the clinician's choice, without any claim to single out an ideal technique.
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Affiliation(s)
- Thierry Gillart
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital, Clermont Ferrand, France.
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Abstract
Elderly patients still have the highest postoperative mortality and morbidity rate in the adult surgical population. Preoperative clinical assessment to detect patients at high risk of postoperative events, and specific intraoperative and postoperative anaesthesia management are important to minimize postoperative adverse events in the elderly.
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Affiliation(s)
- F Jin
- Department of Anaesthesia, University of Toronto, Toronto Western Hospital, Ontario, Canada
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Dhingra N. Myocardial ischemia in cataract surgery patients. Anesth Analg 2001; 93:518. [PMID: 11473894 DOI: 10.1097/00000539-200108000-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dhingra N. Myocardial Ischemia in Cataract Surgery Patients. Anesth Analg 2001. [DOI: 10.1213/00000539-200108000-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wong TY. Effect of increasing age on cataract surgery outcomes in very elderly patients. BMJ (CLINICAL RESEARCH ED.) 2001; 322:1104-6. [PMID: 11337443 PMCID: PMC1120237 DOI: 10.1136/bmj.322.7294.1104] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- T Y Wong
- Department of Ophthalmology, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260.
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