Aeroplanes rarely crash nowadays, therefore they don’t need pilots: anaesthesia, anaesthetics and cataract surgery

Guise, Philip A

doi:10.1111/j.1442-9071.2005.01060.x

Cited by 8 publications

(6 citation statements)

References 14 publications

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“…Guise likens cataract surgery without an anaesthetist to an aeroplane without a pilot 3 . He quotes a study of over 1000 cataract operations in which ‘intervention’ was required by anaesthetic personnel in over 37% of cases.…”

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confidence: 99%

Routine cataract surgery without the presence of an anaesthetist

Kent-Smith

Wallace

2007

Clinical Exper Ophthalmology

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confidence: 99%

Routine cataract surgery without the presence of an anaesthetist

Kent-Smith

Wallace

2007

Clinical Exper Ophthalmology

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“…Surgeon and anaesthetist preference as well as the patient's health and psychological status currently influence the choice of technique. The complication rate is low; however, the large number of patients presenting for surgery each year means that even a small increase in the complication rate will lead to a significant number of patients suffering potentially serious complications 21 …”

Section: Discussionmentioning

confidence: 99%

“…The complication rate is low; however, the large number of patients presenting for surgery each year means that even a small increase in the complication rate will lead to a significant number of patients suffering potentially serious complications. 21 A significant proportion of older people with cataract will have coexisting cardiovascular diseases, with many of these diseases undiagnosed before cataract surgery. 22 Several studies have reported the medical comorbidities found in cataract patients; however, systemic complications related to surgery are rarely and not systematically reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Adverse medical events associated with cataract surgery performed under topical anaesthesia

Sharwood

Thomas

Roberts

2008

Clinical Exper Ophthalmology

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“…The first‐line anaesthetic choice for cataract phacoemulsification surgery remains controversial 1,2 . An effective and commonly employed technique is the sub‐Tenon's block (STB).…”

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“…An effective and commonly employed technique is the sub‐Tenon's block (STB). The STB provides better intraoperative analgesia, 2 patient satisfaction 3 and better pupillary dilation 3 compared with topical anaesthesia. It also avoids sharp needle‐related block complications 4 .…”

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A simple technique to minimize conjunctival haemorrhage following sub‐Tenon's block

Fredrickson

Mantell

Watson

et al. 2007

Clinical Exper Ophthalmology

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A simple technique to minimize conjunctival haemorrhage following sub-Tenon's blockThe first-line anaesthetic choice for cataract phacoemulsification surgery remains controversial. 1,2 An effective and commonly employed technique is the sub-Tenon's block (STB). The STB provides better intraoperative analgesia, 2 patient satisfaction 3 and better pupillary dilation 3 compared with topical anaesthesia. It also avoids sharp needle-related block complications. 4 A disadvantage of the STB is conjunctival haemorrhage (CH). CH associated with STB may be classified as presurgical (early) or postsurgical (late). The reported incidence of early CH ranges from 6% to 100%; 4,5 however, the observational study where the reported incidence of CH was low 4 was not conducted specifically to assess this parameter. A clinical trial designed specifically to assess the incidence of this adverse effect found that CH occurred in 17% of non-anticoagulated patients. 6 CH can occur despite an atraumatic conjunctival incision and may persist for 1-2 weeks postoperatively. This can be a cause of patient concern and potentially reduced patient satisfaction.Over the last 2 years, we have employed a simple technique in an attempt to minimize CH. Following completion of the STB, digital ocular pressure (DOP) is applied directly over the lower eyelid overlying the conjunctival incision. Light pressure with the index finger is maintained for 2 min, thereby minimizing conjunctival vessel leakage while intravascular coagulation occurs.To evaluate this practice formally, we conducted a prospective observational study to assess the incidence and severity of early CH when DOP was employed. Following institutional approval and informed consent, 104 consecutive patients scheduled for cataract phacoemulsification surgery under the anaesthetic care of the principal investigator were included. Exclusion criteria included a STB in the operative eye within the previous 3 months.Sub-Tenon's blocks were placed as previously described 4 with 3-4 mL of lignocaine 2% mixed with hyalase 50 IU/mL. This was immediately followed by DOP as detailed above. Preoperative aspirin and warfarin administration were recorded. The principal investigator assessed the STB on a yes/no basis for technical difficulty with insertion and poor patient cooperation. CH was graded by the surgeon just before the corneal incision on a four-point scale as follows:Limited to the edges of the conjunctival incision • Limited to one quadrant • More than one quadrantThe mean patient age was 71 years and 67% were female. Aspirin use was present in 36 patients. One patient was on a therapeutic dose of warfarin. Blocks were judged as being technically difficult in nine patients and a further three patients cooperated poorly. Grades 1, 2, 3 and 4 haemorrhage was present in 69%, 23%, 6% and 2% of patients, respectively. Early CH that could be visible to the naked eye was therefore avoided in more than 92% of patients. Three out of the nine patients who were judged as having a technically difficult b...

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Aeroplanes rarely crash nowadays, therefore they don’t need pilots: anaesthesia, anaesthetics and cataract surgery

Cited by 8 publications

References 14 publications

Routine cataract surgery without the presence of an anaesthetist

Routine cataract surgery without the presence of an anaesthetist

Adverse medical events associated with cataract surgery performed under topical anaesthesia

A simple technique to minimize conjunctival haemorrhage following sub‐Tenon's block

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