Is fasting required before cataract surgery? A retrospective review

Sanmugasunderam, Suren; Khalfan, Aniz

doi:10.3129/i09-156

Cited by 18 publications

(8 citation statements)

References 6 publications

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“…Thus, these treatments are usually not discontinued before surgery. Preoperative fasting does not appear necessary in case of topical anaesthesia and can even be destabilizing for elderly patients 31 . The patients in the current study were instructed to eat normally on the day of surgery and to continue all their usual treatments in order to modify their usual routine as little as possible.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

Duroi

Baudet²,

Bigoteau

et al. 2021

Sci Rep

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This study aims to evaluate the safety and patient satisfaction of a fast-track procedure for cataract surgery under topical anaesthesia without perioperative anaesthesia care. This is a prospective single-centre study including all cataract procedures in the Centre Ambulatoire de la Chirurgie de la Cataracte at the Hospital of Bourges between May and August 2018. Procedures were performed under topical anaesthesia without the presence of a nurse anaesthesiologist or anaesthesiologist, the patient had not fasted, and no peripheral venous line was placed. Only heart rate and oxygen saturation were monitored intraoperatively with pulse oximetry. Incidence and nature of intraoperative adverse events and surgical complications were recorded. Patient satisfaction was assessed using the Iowa Satisfaction with Anaesthesia Scale (ISAS). In total, 651 cataract surgeries were performed among which 614 (94.3%) were uneventful. Thirty (4.6%) intraoperative adverse events and 8 (1.2%) surgical complications were recorded. All surgeries were successfully completed. No medical emergency team intervention or hospital admittance was encountered. The mean ISAS score was 5.7/6, indicating high patient satisfaction. Cataract surgery in an ambulatory cataract surgery centre without perioperative anaesthesia care is a safe procedure with high patient satisfaction for screened patients. Anaesthesia ressources are scarce and may be more beneficial to more complex ophthalmic or non-ophthalmic surgeries.

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Section: Discussionmentioning

confidence: 99%

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

Duroi

Baudet²,

Bigoteau

et al. 2021

Sci Rep

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“…Procedural sedation is regularly performed in other settings in which fasting is frequently incomplete: cardiac catheterisation [80]; therapeutic abortions [81]; eye surgery [82][83][84][85]; and abdominal imaging in children who have first received oral contrast [86][87][88]. None of these settings have been identified as showing an increased aspiration risk.…”

Section: Acutely Ill or Injured Patients Presenting To Emergencymentioning

confidence: 99%

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Green¹,

et al. 2019

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The multidisciplinary International Committee for the Advancement of Procedural Sedation presents the first fasting and aspiration prevention recommendations specific to procedural sedation, based on an extensive review of the literature. These were developed using Delphi methodology and assessment of the robustness of the available evidence. The literature evidence is clear that fasting, as currently practiced, often substantially exceeds recommended time thresholds and has known adverse consequences, for example, irritability, dehydration and hypoglycaemia. Fasting does not guarantee an empty stomach, and there is no observed association between aspiration and compliance with common fasting guidelines. The probability of clinically important aspiration during procedural sedation is negligible. In the post-1984 literature there are no published reports of aspiration-associated mortality in children, no reports of death in healthy adults (ASA physical status 1 or 2) and just nine reported deaths in adults of ASA physical status 3 or above. Current concerns about aspiration are out of proportion to the actual risk. Given the lower observed frequency of aspiration and mortality than during general anaesthesia, and the theoretical basis for assuming a lesser risk, fasting strategies in procedural sedation can reasonably be less restrictive. We present a consensus-derived algorithm in which each patient is first risk-stratified during their pre-sedation assessment, using evidence-based factors relating to 374 This statement presents the first fasting and aspiration prevention recommendations specific to procedural sedation.

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“…Hence, we were not able to identify specific characteristics significantly associated with an underestimation or an overestimation of time. Although evidence suggests that fasting prior to cataract surgery under topical anaesthesia can be abandoned, in this series, the patients fasted from midnight on the day prior to their surgery 24. As our patients were operated from 8:00 to 14:00, the fasting time varied from one case to another, but these variations did not influence the subjective assessment of the duration of surgery.…”

Section: Discussionmentioning

confidence: 89%

Patients’ subjective assessment of the duration of cataract surgery: a case series

et al. 2013

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ObjectivesSurgery duration is a source of preoperative anxiety for patients undergoing cataract surgery. To better inform patients, we evaluated the agreement between objective and patient-perceived surgery durations.DesignCase series.SettingPublic teaching university hospital (Paris, France).ParticipantsDuring the study period, 368 cataract surgery cases performed on 285 patients were included, 85 cases were excluded from the final analysis. All patients who had uneventful phacoemulsification were included. Cases with any significant intraoperative adverse event or cases requiring additional anaesthesia other than topical were excluded. Resident performed cases were also excluded.Primary and secondary outcomesProcedures were timed (objective duration) and patients were asked, immediately afterwards, to assess the duration of their surgery (patient-assessed duration). The agreement between objective and patient-assessed durations as well as influencing factors was studied.ResultsMean objective duration (13.9±5 min) and patient-assessed duration (15.3±6.9 min) were significantly correlated (Spearman's r=0.452, p<0.0001). Furthermore, Bland-Altman analysis and the intraclass correlation coefficient (0.341, 95% CI 0.23 to 0.44) were quite in agreement. On univariate analysis, senior-performed procedures were significantly shorter than those performed by juniors (13.4 vs 17.8 min, p=0.0001). Pain was recorded as ‘no sensation’ (31.5% of the cases), ‘mild sensation’ (41%), ‘moderate pain’ (23.3%), ‘intense pain’ (3.5%) and ‘unbearable pain’ (0.7%). Groups with high pain score had significantly longer procedures (p<0.001). Multivariate analysis revealed that the only independent factors associated with both the objective and patient-assessed durations of surgery were surgeon's experience and pain-score.ConclusionsIn our study, patients’ estimated and real duration of the surgery showed moderate agreement, suggesting that emotions associated with eye surgery under topical anaesthesia did not dramatically hinder the patients’ perception of time. However, the benefit of preoperative counselling regarding the duration of surgery will need further evaluation.

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Is fasting required before cataract surgery? A retrospective review

Cited by 18 publications

References 6 publications

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

Ambulatory cataract surgery centre without perioperative anaesthesia care: a prospective cohort study

An international multidisciplinary consensus statement on fasting before procedural sedation in adults and children

Patients’ subjective assessment of the duration of cataract surgery: a case series

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