The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study

Oral anxiolytics prior to routine resident cataract surgery eliminate need for intravenous sedation at a Veterans Affairs Hospital

Purpose

To assess the frequency of intraoperative intravenous sedation administration during routine resident-performed cataract surgery among patients receiving pre-operative oral sedation at a Veterans Affairs Medical Center and its impact on patient safety and system cost.

Methods

Retrospective review of all resident-performed cataract surgeries performed at the Iowa City Veterans Affairs Medical Center in 2013 and 2017. Cases monitored by a registered nurse were included. Combined cases and cases monitored by an anesthesia provider were excluded. Pre-operative placement of an intravenous (IV) catheter, administration of intra-operative IV sedation, oral diazepam administration, anesthesia type, conditions for administering intraoperative IV medication, and cost of IV catheter placement were recorded.

Results

Of 1025 patient cases included for analysis, 972 received pre-operative diazepam (94.9%) and 1017 (99.3%) had IV catheters placed. One patient received a planned dose of IV methylprednisolone. Zero patients received supplemental intraoperative IV sedation. The estimated materials cost of unused IV catheters was $10,668 over 2 years.

Conclusions

Pre-operative IV catheter placement may not be necessary in patients undergoing routine resident cataract surgery with pre-operative oral sedation. Discontinuation of routine IV placement may improve patient satisfaction and decrease health care costs without compromising patient safety.

Use of Virtual Reality to Reduce Anxiety and Pain of Adults Undergoing Outpatient Procedures

(1) Background: Research has demonstrated that virtual reality (VR) has reduced pain and anxiety for patients undergoing health procedures. The aim of this quality improvement project was to implement and evaluate immersive VR as a non-pharmacological intervention to reduce pain and anxiety in those adults undergoing outpatient procedures under monitored anesthesia care. (2) Methods: This quality improvement project incorporated the Plan-Do-Study-Act (PDSA) model and employed a pre/post-implementation evaluation. Seven patients used VR during outpatient surgeries. Pain and anxiety scores were evaluated. (3) Results: Patients using VR exhibited lower pain and anxiety scores post-procedure compared to pre-procedure. Both patients and providers indicated high satisfaction with the VR experience. (4) Conclusions: This quality improvement project demonstrated the successful translation of research into practice. VR is a novel intervention that can reduce both pain and anxiety to improve the patient’s perioperative experience.

A Primary Care Provider's Guide to Cataract Surgery in the Very Elderly

Planning for cataract surgery and perioperative care in the very elderly requires the teamwork of the patient's primary care provider and the ophthalmologist.