Cataract surgery
Anesthesia type



Noninvasive O2

Lines and access

Peripheral IV


Standard 5-lead ECG

Primary anesthetic considerations

Dysrhythmias Oculocardiac reflex

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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
  • Uncontrolled movement disorders, significant anxiety, or agitation may warrant general anesthesia.
  • Patients with chronic cough may warrant general anesthesia.
  • Assess for GERD. Patient will need to lay flat and therefore at increased risk for aspiration
  • Antiplatelet or anticoagulant drugs generally do not have to be stopped prior to cataract surgery given the low risk and minimal blood loss

Labs and studies

  • N/A

Operating room setup

  • Nasal cannula
  • Drape retractor for comfort (optional)

Patient preparation and premedication

  • N/A

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


  • 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%
  • Oculocardiac reflex, caused by traction on extraocular muscles, can result in rapid decrease in heart rate and blood pressure.


Postoperative management


  • 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

Surgical time
Postoperative disposition
Pain management
Potential complications


  1. Fang, Zhuang T.; Keyes, Mary A. (2006). "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.