Peri‐operative considerations for sedation‐analgesia during cataract surgery: a narrative review

Abstract

Summary Cataract surgery is usually of short duration and is associated with minimal pain when employing topical or regional anaesthesia. Patient education regarding the peri‐operative process may help alleviate anxiety and avoid the need for sedation. However, sedation may be required, and we discuss the various options. Many consider that pre‐operative fasting is necessary due to the risk of aspiration but fasting may not be required if minimal sedation is administered. If the use of sedatives, hypnotics or analgesics is required, then their associated adverse events should be considered.

Fear and Anxiety Associated with Cataract Surgery Under Local Anesthesia in Adults: A Systematic Review

“… 26 Fasting has been found to cause a number of undesirable emotions in patients, including anxiety, irritability, and anger, often accompanied by headaches. 27 , 28 Other negative effects of abstaining include dehydration, hypovolemia, hypotension, catabolism, and insulin resistance. On the other hand, fasting before surgery under local anaesthesia provides the possibility of conversion to general anaesthesia or airway manipulation in a critical situation.…”

“…It is dictated by many factors, including resources, healthcare system policy, institutional practice, tradition, patient expectations, and preferences of ophthalmologists and anesthesiologists. There are countries where sedation appears to be routinely used for cataract surgery, such as Singapore, 27 the USA, 37 and Canada. 38 There are also countries where the frequency of sedation is negligible, such as in the UK (4%) 39 or absent, such as in the Netherlands.…”

Comment on “Pain Perception of the First Eye versus the Second Eye during Phacoemulsification under Local Anesthesia for Patients Going through Cataract Surgery: A Systematic Review and Meta-Analysis”

“…Actually, this study urged us to rethink the initiation of sedation and analgesia in patients undergoing cataract surgery. In fact, sedation is routinely administered for cataract surgery in some regions of the world, whereas other countries have very low rates of sedation, or none at all, considering their potential side effects (e.g., respiratory depression) [4]. Similarly, we observed that patients in most of the included studies of this meta-analysis did not accept any sedatives and/or analgesics.…”

Cataract Surgery with Systemic Diseases: Is Perioperative Management Necessary?

“…On a case-tocase basis, anxious or uncooperative patients may require sedation in addition to regional anesthesia. Discussing the peri-operative process with the patient prior to surgery may help alleviate anxiety and avoid the need for sedation [18].…”