Effectiveness of monitored anesthesia care in cataract surgery

Abstract

Objective: To determine the need for monitored anesthesia care in cataract surgery by evaluating the incidence of intervention by anesthesia personnel and by looking for associated risk factors.

Design: Nonrandomized, prospective case series with analysis of consecutive cataract surgery cases.

Participants: A total of 1006 consecutive cataract surgery patients at an ambulatory surgery center over a 6-month period.

Methods: Routine cataract surgery was performed with the patient under local anesthesia. A detailed questionnaire was completed by the anesthesia personnel at the conclusion of each phase (before, during, and after) of cataract surgery.

Main outcome measures: Age, medical history, and preoperative electrocardiogram (EKG) were analyzed as predictors for intervention by anesthesia personnel. The nature of the patient's problem and the type of intervention by anesthesia personnel were recorded.

Results: In 1006 consecutive cataract surgery cases, intervention by anesthesia personnel was required in 376 (37.4%) cases. No preoperative identifying characteristics were found to be reliable predictors of the need for intervention. There were no statistically significant differences in preoperative EKG and some medical conditions such as heart disease, diabetes, and thyroid disease between patients who received intervention and those who did not. Certain subgroups of patients did show a statistically significantly greater incidence of intervention, including systemic hypertensives (41.4%) versus nonhypertensives (34.5%) (P = 0.030), patients with pulmonary disease (49.3%) versus no pulmonary disease (36.5%) (P = 0.043), patients with renal disease (68.8%) versus no renal disease (36.9%) (P = 0.019), and patients with cancer (61.9%) versus no cancer (36.3%) (P = 0.001). Intervention was also required in 61.1 % of patients younger than 60 years of age compared to 36.5% of those patients 60 years of age and older (P = 0.005).

Conclusions: Because intervention is required in more than one third of cataract surgery cases and the authors cannot reliably predict those patients at risk, monitored anesthesia care seems justified in cataract surgery with the patient under local anesthesia.