Cataract Extraction

Anesthesia Implications

Position: Supine, arms free at side
Time: 5-30 min (very short)
Post-op Pain: Zero
Maintenance Paralytic: No

Most of these surgeries are done with localizing eye drops and an anxiolytic. Some surgical centers don’t require routine presurgical investigations and even allow the patient to eat/drink until 2-3 hours before the procedure.

Assess INR/APTT (if on warfarin or heparin), BG if diabetic, ability to lie flat for 1 hour, hearing/comprehension (ability to follow commands), and anxiety levels

Most of the population having this surgery are going to be elderly with comorbidities.

Minimal sedation. Typically 1-2 mg of versed. Some will augment with a 50-100 mcg of fentanyl. Others opt to use PO valium (5 – 10 mg). The MKO Melt (Midazolam, Ketamine, Ondansetron) can also be used in younger patients, but the expense for this drug is high. Since this varies far and wide, consider asking the doctors preference.

The key is that the patient needs to be able to follow commands.

An ophthalmic solution is given to dilate the eye ~15-20 minutes prior to surgery. Depending on the facility, this may be given by anesthesia or preoperative nurses. Common solutions include 1% Tropicamide, 1% Cyclopentolate Hydrochloride, and 2.5% Phenylephrine Hydrochloride.

Ophthalmic tetracaine is the common solution used to localize the trigeminal nerve endings in the cornea and conjunctiva. 2-3 administrations is common. Some practitioners will apply 2 drops when they meet the patient, 2 drops before they roll to the room, and 2 drops after the monitors are on.

Patient typically stays on the preoperative bed.

When applying the nasal cannula, loop the cannula and wrap around the ear to keep it out of the surgical field.

Aspirin does not need to be stopped prior to this surgery.

Retrobulbar, intraconal, peribulbar, or extraconal blocks can be performed if the surgeon requires akinesis.

In the rare case that this surgery requires general anesthesia, the routine general anesthesia investigations and NPO guidelines should be observed.

From the Pros – “We have been using ketamine 10-20 mg with versed 1-2mg, instead of fentanyl.  It really holds the eye in a nice forward gaze, and less nausea, and no nose itching. I do not see increased secretions [to justify the need for robinul] with this dose of ketamine.
Just thought I would share as it improved our practice greatly.”