A prospective randomised study of local versus general anaesthesia for cataract surgery

Abstract

One hundred and sixty-nine patients (aged 65-98 years) were randomised to receive either local or general anaesthesia for cataract surgery. Cognitive function was assessed using a battery of psychometric tests performed pre-operatively. and at 24 h, 2 weeks and 3 months postoperatively. Oxygen saturation, blood pressure and heart rate were monitored and the results recorded throughout the anaesthetic and immediate recovery period. In the general anaesthetic group, 19% of patients experienced at least one episode of oxygen desaturation during the procedure compared with none in the local anaesthetic group. Pulse rate and blood pressure were stable in the local anaesthetic group compared with the general anaesthetic group where marked fluctuations were noted; 61 % of patients in the general anaesthetic group experienced falls in systolic blood pressure greater than 30% of the preinduction value. No evidence of long-term postoperative cognitive dysfunction was detected and there was no signijicant digerence between the performances of the two groups. Key wordsAnaesthesia, general. Anaesthesia, local. Surgery; cataract extraction. Brain; cognition; memory.The proposition that the elderly patient is particularly susceptible to cognitive dysfunction following general anaesthesia was first advanced by Bedford in 1955 [I]. Subsequent studies [2-121 have failed to dispel this fear and the putative risk of long-term cognitive impairment following general anaesthesia in the elderly was re-iterated in a recent editorial [13].Although there is a growing interest in the use of local anaesthesia (LA) for cataract surgery, the majority of such operations in the United Kingdom are still performed under general anaesthesia (GA). The relative merits of these two techniques have been discussed recently [14], but few studies have attempted a prospective, controlled evaluation. In particular, the effects on cognitive and functional competence following each technique have yet to be fully resolved. This prospective study was undertaken to evaluate differential changes in cognitive function after LA or GA for cataract extraction in elderly patients and to establish whether episodes of hypotension or hypoxia during anaesthesia had any influence on outcome. MethodAfter institutional ethics committee approval had been obtained, we studied 169 patients, aged greater than 65 years, scheduled for elective cataract extraction; all gave informed consent. Patients were not studied if any of the following criteria were fulfilled: (a) surgical contraindication to LA, (b) inability to communicate due to severe deafness or poor command of English, (c) uncontrolled hypertension (diastolic blood pressure > 1 15 mmHg), (d) myocardial infarction within the previous 6 months, (e) uncontrolled heart failure, (f) severe respiratory disease, (g) acute neurological or psychiatric illness. Patients either had their surgery as inpatients or were treated on an outpatient basis. Patients in each category were randomised separately to receive either local anaest...

The Cataract National Dataset Electronic Multi-centre Audit of 55 567 operations: anaesthetic techniques and complications

“…[4][5][6] The use of sedation with local anaesthesia (LA) has fallen from 6% in 1996 5 to 3.9% in 2003. 4,6 Day case ophthalmic surgery under LA has been shown to be safe [7][8][9] and is associated with the least disruption to the patient's normal daily activity. 9, 10 The choice of anaesthesia depends on a number of factors, including patient psychology, the particular features of the globe and the orbit, the anticipated surgical difficulty and the experience of the operating surgeon.…”

Evidence-based clinical update: General anesthesia and the risk of delirium and postoperative cognitive dysfunction

“…Of the eight trials reviewed two employed validated tools for the detection and diagnosis of delirium, 3,11 two relied on institution-specific questionnaires that had not been validated, 4,17 and the remainder relied on reports of patient behaviour from health care workers and family. In the absence of a formal screening tool both physicians and nurses fail to diagnose delirium in over twothirds of cases.…”

“…[3][4][5][6][7][8][9][10][11][12] Hand search identified an additional 17 articles [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] so that a total of 27 articles were reviewed in detail. Seven publications were excluded for using a non-randomized 18,19,24,27,29 or pseudo-randomized designs.…”

Postoperative Cognitive Dysfunction in Older Patients With a History of Alcohol Abuse

“…52 Diabetes and mood disorders are frequently observed in alcoholics and influence cognitive performance. 3,[53][54][55][56][57] It is known that depression influences specific areas of cognition, notably attention, 58 and it seems to be partly involved in the decline of cognitive performance after anesthesia. 59 The fact that alcoholic patients were more likely to need postoperative admission to the ICU or ward than the nonalcoholic patients may be indicative of a compromise in the general health of alcoholics.…”