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

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
  • 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

  • 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

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)
  • 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

  1. 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)