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