Anaesthesia for Cataract Surgery
- 1 January 2010
- journal article
- review article
- Published by Springer Science and Business Media LLC in Drugs & Aging
- Vol. 27 (1), 21-38
- https://doi.org/10.2165/11318590-000000000-00000
Abstract
Cataract surgery is the most frequent surgical procedure requiring anaesthesia in developed countries. It is performed mainly in elderly patients, who present with many coexisting diseases that induce subsequent hazards from general anaesthesia. Cataract anaesthesia is performed following various techniques of regional anaesthesia, which are detailed in this review. Needle block carries a low but real risk of complications, mainly because of needle misplacement. Correct teaching and training are mandatory to prevent complications. The main patient risk factor for inadvertent globe perforation is the presence of a myopic staphyloma. Retrobulbar block has been progressively phased out and replaced by peribulbar block, sub-Tenon’s block (STB) or topical anaesthesia (TA). The requirement for very deep block with total akinesia has greatly decreased with the use of phacoemulsification for cataract surgery, allowing for use of TA or low-volume STB. However, non-akinesia techniques may give rise to impaired surgical conditions, which have the potential to result in surgical complications. A surgical approach to accessing sub-Tenon’s space avoids needle block, but does not totally prevent complications. When deep anaesthesia is required, low-volume STB, performed using either the needle technique or a surgical approach, appears to be the technique of choice in terms of efficacy. Increasing the anaesthetic volume provides reproducible akinesia. Various local anaesthetics may be used, depending on their availability and respective properties. The most useful adjuvant to local anaesthetic is hyaluronidase.Keywords
This publication has 126 references indexed in Scilit:
- Adverse medical events associated with cataract surgery performed under topical anaesthesiaClinical & Experimental Ophthalmology, 2008
- The fourth New Zealand cataract and refractive surgery survey: 2007Clinical & Experimental Ophthalmology, 2008
- Comparison of a bupivacaine 0.5% and lidocaine 2% mixture with levobupivacaine 0.75% and ropivacaine 1% in peribulbar anaesthesia for cataract surgery with phacoemulsificationActa Ophthalmologica Scandinavica, 2007
- Serious complications of local anaesthesia for cataract surgery: a 1 year national survey in the United KingdomBritish Journal of Ophthalmology, 2006
- A comparison of anterior and posterior chamber lenses after cataract extraction in rural Africa: a within patient randomised trialBritish Journal of Ophthalmology, 2004
- Effects of Atracurium Added to Local Anesthetics on Akinesia in Peribulbar BlockRegional Anesthesia & Pain Medicine, 2002
- Globe perforation by the second peribulbar injectionEye, 2002
- Retrobulbar Versus Systemic Application of Morphine During Titratable Regional Anesthesia via Retrobulbar Catheter in Intraocular SurgeryAnesthesia & Analgesia, 2000
- A 5‐year survival study of general surgical patients aged 65 years and overAnaesthesia, 1996
- A Dose-Response Study of Orally Administered Clonidine as Premedication in the ElderlyAnesthesia & Analgesia, 1993