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Inger M. Westborg, Eva Mönestam; Intracameral Anesthesia For Cataract Surgery, A Population-based Study On Patient Satisfaction And Outcome. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6638.
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To analyze the outcome of the anesthetic regimen and sedation in a cohort of unselected cataract surgery cases. The goal was to evaluate if the standard anesthetic regimen and preoperative sedation is adequate and good practice or if improvements are necessary. An evaluation of patient satisfaction was included.
We conducted a prospective, observational, population-based study on all patients having small-incision phacoemulsification surgery during a 1-year period, at one institution. Data were collected from the patients’ records, which for cataract surgery are standardized at the clinic. Outcome measures were; use of preoperative sedation, type of anesthesia, complications and adverse events. In a subgroup of patients (n=124) an analysis of the satisfaction with the chosen anesthetic regimen was made using a short questionnaire (VAS scale1-10).
The study included 1249 cases with a mean age of 74.1 years. (range 22-96). All patients had day-case surgery. The majority (n=781; 63%) had first eye cataract surgery, 450 cases (36%) were second eye surgery and 9 patients (1%) had same day bilateral cataract surgery.Most patients (90%) had combined topical and intracameral anesthesia without sedation.Only 7.4 % of the cases had preoperative sedation (Midazolamhydrochloride sublingually),of whom women and younger patients chose preoperative sedation in a significantly higher degree (p=0.011 and p=0.000, respectively).Supplementary anesthetics during surgery were administered to 3 of 94 patients (3%) with preoperative sedation, and 83 of 1156 patients (7 %) with no preoperative sedation (p= 0.21).The median pain score 15 minutes after surgery was 0.7. A pain score of 1.7 or less was reported by 75% of the patients. There was no significant difference between patients with pain score 1 or less or 1.5 or higher regarding sex, first or second eye surgery, any sedation, mean pulse rate,any need for additional anesthetics and adverse intraoperative events.
This large series of small-incision phacoemulsification surgery shows that combined topical and intracameral anesthesia without sedatives appears to be efficacious and well tolerated for most patients. However, it is important to be responsive to the individual patient needs and adjust operating procedures if necessary.
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