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MK Chang, M McDermott, E Chidiac; Comparative Analysis of Intravenous Sedation and Analgesia During Cataract Surgery: Topical versus Retrobulbar Anesthesia . Invest. Ophthalmol. Vis. Sci. 2002;43(13):364.
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Purpose: To compare the amount of intravenous sedation and analgesia administered during cataract surgery using topical versus retrobulbar anesthesia, and to determine whether greater amounts of intravenous medications were related to increased post-operative recovery room times, total discharge times, and increased systemic adverse events between the two groups. The significance of increased post-operative observation times would be that it could potentially increase the cost of cataract surgery. Methods: A retrospective, comparative study reviewing forty-four anesthesia charts of cataract surgeries performed by two cataract specialists. All patients received intra-operative intravenous midazolam and fentanyl, and underwent clear corneal extracapsular cataract extraction with posterior chamber intraocular implantation. Total operating room time, procedure time, number intra-operative blood pressure spikes (defined as a rise in systolic blood pressure ≷ 20 mmHg), and number of adverse systemic events were also compared. Results: The mean inta-operative levels of IV midazolam was 26 ug/kg and 18 ug/kg in the topical and retrobulbar groups respectively, with a p-value of 0.001. The mean intra-operative levels of IV fentanyl was 0.99 ug/kg and 0.69 ug/kg in the topical and retrobulbar groups respectively, with a p-value of 0.003. The mean total post-operative recovery room times were 91 minutes and 84 minutes for the topical and retrobulbar groups respectively, and was not statistically significant. The rate of adverse events were similar, and not significant. Conclusion: There exists a statistically significant increase in the amount of intravenous sedation and analgesia administered to patients undergoing topical anesthesia versus retrobulbar anesthesia. Higher levels of intravenous sedation and analgesia have the potential to cause adverse systemic effects especially in the elderly population. However, the additional amounts of sedation and analgesia did not significantly increase the recovery room times and total discharge times of the topical anesthesia group as compared to the retrobulbar group. The cataract surgeon ought to have a clear understanding of their anesthetic strategy and options, and to be aware of the levels of intravenous sedation and analgesia administered so as to not impart any unnecessary risk to the patient.
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