Cataract surgery

From WikiAnesthesia
Revision as of 12:36, 30 March 2021 by Eeshwar Chandrasekar (talk | contribs) (Created page with "A cataract surgery is usually an elective surgery in which the opacified lens of the eye is replaced with an artificial intraocular lens. This common surgical procedure is usu...")
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)

A cataract surgery is usually an elective surgery 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.

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
In development
User likes
0

Preoperative management

Patient evaluation

System Considerations
Neurologic
  • Uncontrolled movement disorders, significant anxiety, or agitation may warrant general anesthesia.
Cardiovascular
Respiratory
  • Patients with chronic cough may warrant general anesthesia.
Gastrointestinal Assess patient's risk
Hematologic Antiplatelet or anticoagulant drugs generally do not have to be stopped prior to cataract surgery given the low risk and minimal blood loss
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

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
  • Benzodiazapenes (ex. midazolam) and opioids (ex. fentanyl) are commonly administered throughout the case as needed for patient comfort

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
  • Anesthesiologists should monitor

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)

Potential complications

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References