April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Quality of ophthalmic anaesthesia and surgical outcome
Author Affiliations & Notes
  • Stephen Kaye
    Ophthalmology, Royal Liverpool Univ. Hospital, Liverpool, United Kingdom
    Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
  • Natasha Spiteri
    Ophthalmology, Royal Liverpool Univ. Hospital, Liverpool, United Kingdom
  • Gabriela Czanner
    Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
  • Mark Batterbury
    Ophthalmology, Royal Liverpool Univ. Hospital, Liverpool, United Kingdom
    Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
  • Gediminas Sidaris
    Anaesthesia, Royal Liverpool Univ. Hospital, Liverpool, United Kingdom
  • Footnotes
    Commercial Relationships Stephen Kaye, None; Natasha Spiteri, None; Gabriela Czanner, None; Mark Batterbury, None; Gediminas Sidaris, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 2545. doi:
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      Stephen Kaye, Natasha Spiteri, Gabriela Czanner, Mark Batterbury, Gediminas Sidaris; Quality of ophthalmic anaesthesia and surgical outcome. Invest. Ophthalmol. Vis. Sci. 2014;55(13):2545.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To develop and validate a tool for assessing the quality of anaesthesia for ophthalmic surgery

 
Methods
 

An interval scale was developed to grade the quality of anaesthesia for ophthalmic surgery. Consecutive patients undergoing ophthalmic surgery were included. Patients undergoing lid surgery were excluded. Depending on the type and route of anaesthetic administered, each parameter was graded by the operating surgeon (figure). These included: eye position, anaesthesia, akinesia of the eye or body, soft tissue or orbital haemorrhage and vitreous bulge using a scale of 0 (not achieved), 1 (partially achieved) and 2 (fully achieved). An aggregate score was then calculated.

 
Results
 

Data was collected on 349 surgical cases, including cataract (55%), strabismus, retinal (14%) corneal transplantation (6%) and strabismus surgery (6%). Sub-tenons (ST) (31%) was most commonly administered, followed by peribulbar (PB) (26%), general anaesthesia (GA) (20%), topical (17%) and retrobulbar (RB) (6%). 11 surgical complications were documented: posterior capsule rupture (7), dropped nucleus (1) anterior subluxation of the crystalline lens (1) and cancellation of surgery due to haemorrhage (2). There was a significant association between sub-optimal anaesthesia and surgical complications (p<0.01). The odds ratio of complicated versus uncomplicated surgery in patients with sub-optimal anaesthesia was 3.94 (95%CI:1.03-15.12, p<0.046). ST achieved significantly lower scores than PB (p<0.01), RB (p=0.028) and GA (p<0.01). PB and RB anaesthesia were similar (p=0.7) but significantly lower than GA (p<0.01).

 
Conclusions
 

A simple scoring system is presented to evaluate the quality of ophthalmic anaesthetia. The quality of anaesthesia for ophthalmic surgery is associated with the type and route of anaesthesia. Suboptimal anaesthesia is significantly associated with an increased rate of surgical complications. It is important to consider both the type and quality of ophthalmic anaesthesia in surgical planning and in evaluating surgical outcome.

  
Keywords: 465 clinical (human) or epidemiologic studies: systems/equipment/techniques • 462 clinical (human) or epidemiologic studies: outcomes/complications • 743 treatment outcomes of cataract surgery  
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