Study casts doubt on routine use of anesthesiologists in cataract surgery

Medical Xpress / University of California, San Francisco / JAMA Internal Medicine ^ | Oct. 3, 2022 | Dhivya Perumal et al

[ConservativeMind]

Ophthalmologists may be able to safely cut back on having anesthesiologists or nurse anesthetists routinely at bedside during cataract surgery.

Researchers examined Medicare claims for 36,652 patients who had cataract surgery and found the use of anesthesia care was substantially higher for cataract surgery when compared to patients undergoing other elective, low-risk outpatient procedures—such as cardiac catheterization or screening colonoscopy.

However, they found that these patients experienced fewer systemic complications—such as myocardial infarction or stroke—than did patients undergoing the other low-risk procedures. These results held true even in cases where anesthesia experts were not present for the cataract surgery, suggesting that for many cataract patients, it may be reasonable to consider doing the procedure without routine anesthesia support.

"It's important to note we only looked at systemic complications and not ophthalmologic outcomes.

Some type of anesthetic and possibly sedation is needed for cataract surgery, Chen noted.

"The risk of the procedure itself used to require general anesthesia with paralysis and inpatient admission. Over time, ophthalmologists improved their technique so it [cataract surgery] is much safer and can be done on an outpatient basis," said Chen. "Often the patient just needs a topical anesthetic such as numbing drops in the eyeball, and, at UCSF anyway, a little fentanyl and midazolam, which are agents a sedation nurse can administer safely."

With U.S. anesthesiologists being asked to staff an increasing number of non-OR procedures, such as endoscopic or interventional radiology procedures where patients tend to be much sicker and the procedure potentially more invasive, there often aren't enough of these specialists go around, Chen said.

"Add to this a general shortage of anesthesiologists since COVID, and it's clear we need to ensure staff resources are used efficiently," said Chen.

[JoJo354]

I had cataract surgery on both eyes last year. Easy-peasy. The first eye, I was sedated a little too much and was feeling sick on the way home. I told them about that the following week and they didn’t use the same drugs for that second eye and I walked out like I just had an eye check-up. Not sick at all. I think it all depends on who does the sedation.

[Does so]

I had one multifocal implantation.

Returning for an evaluation of the procedure, I couldn’t make out the letters that would have given me 20-20 vision. The technician said, “squint”.
:-/

Be sure you really need cataract surgery. I wanted to be free of rings that formed around a bright light. They’re worse now!

[FamiliarFace]

I was seeing 20/30 the day after my cataract surgery. I know I was blessed with a fantastically talented, very skilled ophthalmologist. I hope he doesn’t retire before my husband needs cataract removal.