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MONITORED ANESTHETIC CARE AND CATARACT SURGERY

Department of Anesthesiology, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK., S7N 0W4

INTRODUCTION

Increasing waitlists and limited anesthesiology manpower demand appropriate allocation of limited anesthesiology resources. Schein et al (1) have shown that routine preoperative medical testing for cataract surgery (CS) is unnecessary. Recently, the need for continuous attendance of an anesthesiologist for CS has been questioned (2–4). The majority of CS performed in our province are undertaken with topical anesthesia (TA). Currently, at one hospital site, anesthesiologists are in constant attendance while at the other less than half the time for CS with TA. This retrospective review was undertaken to determine the incidence of the need for anesthesiologist intervention (AI) for CS performed with TA.

METHODS

Following IRB approval, chart reviews of consecutive CS were performed at the two centers beginning January 1, 2000. The incidence of perioperative AI was determined. Statistical analysis with t-test and Chi square analysis with Yates correction for continuity was performed.

RESULTS

1104 CS were reviewed, 19 excluded, 614 with TA and 471 with peribulbar/retrobulbar block (PRB). Institution (A): anesthesiologists present for all procedures (n=539). Institution (B): anesthesiologist present 46% (250/546). AI at (A) were 3.3% (14/423) TA compared to 18.1% (21/116) PRB (p<0.001). AI at (B) were 2.1% (4/191) TA and 7.6% (27/355) PRB (p<0.05). AI at (B) when the anesthesiologist was not originally present was 0.67% (2/298).

DISCUSSION

The incidence of AI is low suggesting that cataract surgery under topical anesthesia does not require the immediate presence of an anesthesiologist.

REFERENCES

1 NEJM342(3):168–75, 2000;[Abstract/Free Full Text]

2 JAANA65(4):357–60, 1997;

3 Ophthalmology106(7);1256–60, 1999[Medline]

4 ASA Meeting Abstract A-8, 2000

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