Difference between revisions of "Cataract surgery"
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|Gastrointestinal | |Gastrointestinal | ||
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* Assess for GERD. Patient will need to lay flat and therefore at increased risk for aspiration | |||
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|Hematologic | |Hematologic | ||
|Antiplatelet or anticoagulant drugs generally do not have to be stopped prior to cataract surgery given the low risk and minimal blood loss | | | ||
* Antiplatelet or anticoagulant drugs generally do not have to be stopped prior to cataract surgery given the low risk and minimal blood loss | |||
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|Renal | |Renal | ||
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|Endocrine | |Endocrine | ||
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|Other | |Other | ||
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* Lidocaine-propofol-alfentanil mixtures<ref>{{Cite journal|last=Fang|first=Zhuang T.|last2=Keyes|first2=Mary A.|date=2006-03-XX|title=A novel mixture of propofol, alfentanil, and lidocaine for regional block with monitored anesthesia care in ophthalmic surgery|url=https://linkinghub.elsevier.com/retrieve/pii/S0952818005003508|journal=Journal of Clinical Anesthesia|language=en|volume=18|issue=2|pages=114–117|doi=10.1016/j.jclinane.2005.08.007}}</ref> can be used for induction during application of retrobulbar or sub-tenon blocks by proceduralist | * Lidocaine-propofol-alfentanil mixtures<ref>{{Cite journal|last=Fang|first=Zhuang T.|last2=Keyes|first2=Mary A.|date=2006-03-XX|title=A novel mixture of propofol, alfentanil, and lidocaine for regional block with monitored anesthesia care in ophthalmic surgery|url=https://linkinghub.elsevier.com/retrieve/pii/S0952818005003508|journal=Journal of Clinical Anesthesia|language=en|volume=18|issue=2|pages=114–117|doi=10.1016/j.jclinane.2005.08.007}}</ref> can be used for induction during application of retrobulbar or sub-tenon blocks by proceduralist | ||
* Benzodiazapenes (ex. midazolam) and opioids (ex. fentanyl) are commonly administered throughout the case as needed for patient comfort | * Benzodiazapenes (ex. midazolam) and opioids (ex. fentanyl) are commonly administered throughout the case as needed for patient comfort | ||
* Placement of retrobulbulbar or peribulbar blocks can be briefly very painful - consider remifentanil (0.25-1mcg/kg), alfentanil (5-7mcg/kg), or propofol bolus (30-50mg) | |||
** Be prepared to treat sudden decrease in blood pressure or apnea | |||
===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ===Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. -->=== | ||
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* Cataract surgeries are often very short in duration, with case duration ranging on average from 15 mins to 1 hour | * Cataract surgeries are often very short in duration, with case duration ranging on average from 15 mins to 1 hour | ||
* | * Coughing or valsalva should be avoided as much as possible | ||
* If any cautery is used, the delivered FiO2 < 30% | |||
===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ===Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. -->=== | ||
Revision as of 07:10, 1 June 2021
Cataract surgery
| Anesthesia type |
MAC |
|---|---|
| Airway |
Nasal Canula |
| Lines and access |
Peripheral IV |
| Monitors |
Standard ASA / 5 Lead EKG |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
Dysrhythmias, Oculocardiac Reflex |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Cataract surgery is an elective procedure in which the opacified lens of the eye is replaced with an artificial intraocular lens. This common surgical procedure is usually performed among elderly patients as the most common etiology is age-related (90% of cases). Cataract surgery is commonly performed via an extracapsular technique, which involves removing the lens through a small incision in the anterior lens capsule, and phacoemulsification. This is generally preferred to the intracapsular technique, which involves removing the lens and surrounding capsular bag, as the extracapsular approach has improved visual outcomes and fewer adverse reactions.
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic |
|
| Cardiovascular | |
| Respiratory |
|
| Gastrointestinal |
|
| Hematologic |
|
| Renal | |
| Endocrine |
|
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
- Retrobulbar or sub-tenon block can be used in procedure room and OR environments
Intraoperative management
Monitoring and access
- Standard ASA monitors
- 5 Lead EKG
- 1 Peripheral IV
Induction and airway management
- Nasal cannula is commonly used for oxygen supplementation
- Patients are usually awake and alert during procedure, with topical medication commonly administered to operative eye
- Lidocaine-propofol-alfentanil mixtures[1] can be used for induction during application of retrobulbar or sub-tenon blocks by proceduralist
- Benzodiazapenes (ex. midazolam) and opioids (ex. fentanyl) are commonly administered throughout the case as needed for patient comfort
- Placement of retrobulbulbar or peribulbar blocks can be briefly very painful - consider remifentanil (0.25-1mcg/kg), alfentanil (5-7mcg/kg), or propofol bolus (30-50mg)
- Be prepared to treat sudden decrease in blood pressure or apnea
Positioning
- Supine, table usually rotated 90 - 180 degrees
- Protect non-operating eye
Maintenance and surgical considerations
- Cataract surgeries are often very short in duration, with case duration ranging on average from 15 mins to 1 hour
- Coughing or valsalva should be avoided as much as possible
- If any cautery is used, the delivered FiO2 < 30%
Emergence
Postoperative management
Disposition
- Patients usually return home same day after short post-operative observation
Pain management
- Patients usually have minimal pain after procedure (Pain score 1-2)
- PO or IV acetaminophen
Potential complications
Procedure variants
| Femptosecond Laser | Astigmatism Correcting
Lens insertion |
Combined Case | |
|---|---|---|---|
| Unique considerations | Two rooms required | Surgeon must have eye
marked prior to sedation |
|
| Position | |||
| Surgical time | |||
| EBL | |||
| Postoperative disposition | |||
| Pain management | |||
| Potential complications |
References
- ↑ Fang, Zhuang T.; Keyes, Mary A. (2006-03-XX). "A novel mixture of propofol, alfentanil, and lidocaine for regional block with monitored anesthesia care in ophthalmic surgery". Journal of Clinical Anesthesia. 18 (2): 114–117. doi:10.1016/j.jclinane.2005.08.007. Check date values in:
|date=(help)