ELIMINATING UNPLANNED ANAESTHETIC INTERVENTION IN CATARACT OPERATIONS

 Hypertension and anxiety are the most common operative medical complications in patients undergoing cataract surgery under topical anaesthesia. These complications may require unplanned anaesthetic intervention. Our objective was to identify risk factors for high blood pressure or anxiety requiring anaesthetic intervention during cataract surgery and estimate the application of a standardised procedure to eliminate unplanned anaesthetic intervention.

General Hospital of Lamia

All patients undergoing elective cataract operations under topical anaesthesia were included in an observational prospective study preceded by a medical history description and laboratory and electrocardiograph (ECG) testing according to the surgeon’s discretion and the Society for Ambulatory Anaesthesia Position (SAMBA) Statement for Preoperative Care for Cataract Surgery. Treatments were standardized by the anaesthesiologist and given by the nurse anaesthetist after confirmation with the doctor. Intraoperative adverse medical events and type of management (planned versus unplanned anaesthetic intervention) concerning hypertensive or anxiety events were recorded.

We studied 677 elective cataract operations. The overall rate of hypertension during surgery was 18% (n = 122). Independent risk factors for developing intraoperative hypertension were female sex (OR = 3.2 [1.4–9.8]; P = 0.01), age > 80 years (OR = 4.1 [1.3–12.8]; P = 0.01) and anxiety (OR = 9.2 [3.8–24.0]; P = 0.01). The overall rate of anxiety was 14.9% (n=101). Intraoperative risk factors for developing intraoperative anxiety were female sex (OR=2.3 [1.3-8.0]; p=0.028), age <70 years (OR=4.0 [1.5-11.3].  Patients operated on both eyes experienced greater fear and anxiety before the operation of the first eye surgery. Cognitive status did not affect the results; however, it affected the degree of intraoperative cooperation. Management of hypertension or anxiety was similar in patients regardless of their past medical history or ASA risk class. The overall rate of unplanned anaesthetic intervention was 2.5%(n=17).

A specific at-risk population may benefit from targeted preoperative interventions for reducing intraoperative anxiety and hypertension. Individual patient state of mind should be routinely documented and evaluated through a standardized procedure before surgery. This individual preoperative care can decrease anxiety when undergoing surgery. Standardised procedure to treat any intraoperative hypertensive or anxiety events can eliminate unplanned anaesthesiologist call.